As an Oral Health Therapist, patients often want my opinion of the dentist's treatment plan, costs, correct course of treatment etc. What is the best way to handle this?
All health practitioners should not exceed their AHPRA registration scope of practice and qualifications, training and experience. It is inappropriate for an oral health therapist to comment on dental treatment. Many complaints are initiated by the inappropriate comments of practitioners who may not be qualified to comment. AHPRA outlines your scope to colleagues.
Shouldn’t the cost be limited to refunding the cost of the failed treatment and possibly an extraction as it isn’t a responsibility to provide a replacement tooth without a fee?
If the initial treatment is sub optimal (it may have been inappropriate/ contraindicated or performed substandard or negligently) then a potential liability is created. In this case a file was fractured and left in situ. That should not have occurred and should have been identified. Further cost was incurred as a result and they are clearly part of an appropriate claim.
Where is the evidence that the alleged broken file is Dr Tan’s? Any advice?
It is clear from the radio graph that the file occurred during Dr Tan’s treatment. There had been no previous problems and no other recent dental treatment.
As the files are provided by the practice are they responsible?
No. Responsibility lies with the practitioner undertaking the treatment
Given she presented with an unsalvageable tooth why did you settle?
The case was settled because the broken file was not detected, nor explained to the patient and the patient had to explore other avenues. AHPRA had been critical of the member in a number of aspects. In all the circumstances compromising the claim in this way was the most appropriate and economic outcome based on lack of any supporting expert evidence.
Should he have advised the patient of fractured instrument at the time and organised referral?
If it was identified, then absolutely yes. An open, honest and prompt disclosure is expected in your code of conduct. A treatment plan can then be agreed and be put in place, the patient/practitioner relationship is maintained as well as mitigating the potential for further escalation.
If I have left a practice, how can I be certain that any initial complaints made are directed at me? Can a complaint be escalated without my knowledge?
Complaints are usually directed at the practitioner as they are ultimately responsible and accountable for the treatment. Be sure to provide a forwarding address and keep open the lines of communication. Is it unlikely to be escalated without your knowledge.
If it is not within our scope of practice, but we recognise a problem, and we keep quiet, will we be held accountable?
All practitioners have a duty to mandatory report colleagues who meet the notifiable conditions. Mandatory reports have a high threshold. You should contact MIPS to discuss the circumstances before making a mandatory report. In most circumstances you may wish to consider advising the practice principal or manager of your concerns.
My co dentist has some failed fillings/ treatment plans and sometimes I come across them. Should I be mentioning to the patient about the lost fissure seal or other findings?
It is appropriate to advise your patient of what treatment is required but not necessarily what caused it. You may not know the full history or circumstances so steer clear of laying blame. Best to have a frank discussion with the co dentist.
Your advice is refund any patient with a complaint?
Not necessarily. That is a matter for you to consider and as we indicated is not recoverable through MIPS. What we say is that it is a very powerful mitigation tool to prevent an escalation if the patient is not happy with the treatment outcome irrespective of issues of liability and causation.
In regards to infection control, how can a part-time contractor control what goes on in the sterilising room the rest of the week?
You can’t. But you should satisfy yourself that the infection control measures taken to prepare for the treatment you provide is appropriate in accordance with any requirements, as you as the practitioner providing the treatment are the responsible and accountable entity.