Is there any way to find out if any particular training or course is accepted by AHPRA? We spend a lot to do some courses like ortho and implants. How do we know if AHPRA allows us to practice after those course?
As far as I know AHPRA doesn’t “certify “ or “ accredit ” courses so they will allow you to do any course, but then if there is a CPD audit, at that stage AHPRA decides on the merits or otherwise of the course. Some course providers do go to the effort of contacting AHPRA and obtaining an “approval” prior to the course being run which generally means that a certain number of CPD hours are gained.
Do we need to obtain patients’ consent in order to forward copies of records to MIPS?
Not to MIPS as your indemnity provider. However, if records are to be transferred to other sources then a formal consent is required.
As an OHT I often see patients for their examination and clean and the dentist will come in if TX is required. However, I will usually talk to the patient about the process and risks of the treatment. Am I liable in anyway even though I do not actually carry the treatment out?
If, by “treatment”, you mean other treatment beyond a scale and clean and examination, then the person responsible for providing that other treatment is the person who should explain the procedure and obtain the patient’s consent. That would be the responsibility of the treating dentist in the situation outlined, not the OHT.
Under obturation happened, patient informed, patient doesn't want to visit endodontist , monitoring… till now no symptoms. How long should I monitor to avoid a complaint? Patient has signed consent and he is aware of everything. What is the best way to handle it?
Obturation is not the keystone of endodontics. Debridement is the critical element. If the canal was correctly debrided to the appropriate length then the obturation length is a secondary consideration. I would simply review the tooth as normal at periodic review appointments if the patient is unwilling to have the obturation improved/corrected.
With criminal history, under what circumstances does AHPRA cancel or suspend the Registration
As far as I am aware AHPRA may caution/reprimand of fine the practitioner if a criminal history isn’t disclosed but unless the history involved fairly serious offences then I would think things like imposing conditions/suspension etc. would be rare.
If employing new dentist who is still waiting for their provider number, is it possible to allow use of your provider number until they get their number? And if there is a complaint against the new dentist, how does it involve the dentist who is temporarily sharing their provider number?
Short answer… no. If the employee isn’t that provider then they cannot use your provider number. As for the complaint and “temporarily sharing” a provider number… no. There is no “sharing” of provider numbers. It would be akin to “sharing” your driver’s licence with someone else.
My ex-employer was constantly pressuring me to sign SFA contract, even when I signed some other contract at the beginning. Can they really do that?
In this question we presumed SFA stood for Service and Facility Agreement. You may need to obtain independent legal advice if your employer requires you to sign this. In these circumstances employers would normally need to demonstrate that a restructure from having staff as ‘employees’ to an ‘SFA’ had merit and was not simply a tax dodge, otherwise the ATO may impose penalties. This is not an area where MIPS has expertise and you may need to see independent legal advice. We note there is discussion online about this topic: http://www.independentdentist.com.au/tax-man-cometh-contractor-arrangements-sights-2/
You talk a lot about complaints for dentist, do you see a lot of complaints against OHT? What are they generally for?
OHT is a very small percentage. Probably less than 5% of dental complaints and the complaints are the same as dentists, eg poor communication, not obtaining consent, working outside your scope of practice.
Is passing along x-rays to a specialist without patient’s consent wrong?
For any transfer of records one should obtain consent. I would have thought that generally if one is either referring the patient to a specialist or obtaining a specialist opinion the patient would be told about this and agree to it, plus the need to transfer records (eg Radiographs) so the specialist is familiar with the case.
Sometimes the patient would want unidealistic treatments even when they are informed that it’s is not ideal to proceed with that. We put it on records and proceed with what the patient wants. Can it still become serious?
Very serious. If you believe the treatment the patient wants is either inappropriate or unreasonable or, for example, has a limited prognosis, then simply recording this will not prevent a problem if the patient initiates a complaint. If as a dentist you feel the treatment isn’t in the best interest of the patient then do not proceed with the treatment. If it goes wrong the patient will invariably claim they weren’t informed and didn’t properly consent… “If I knew this would be the result I’d have never started the treatment”.
When gaining informed consent, does giving the option of being referred to an endodontist imply that the case was difficult and should've been done by an endodontist instead? Will you end up with more of a liability if the case fails or requires retreatment?
No. Some practitioners refer all endo cases to an endodontist simply because they don’t like doing endo. Often the reason for referral is indeed that the case is difficult… calcified canals, curved canals etc… and it is the intelligent practitioner who recognises the potential difficulty in advance and refers. The practitioner who gets into trouble is the one who decides to ‘give it a try’ and who, on reflection, should have recognised the difficulties of the case not even started treatment, but referred straight up.
If you give a refund, could the patient take that as an admission of liability and still make a complaint?
A refund is done with no admission of liability, but as a genuine attempt to resolve a complaint. However, giving a refund does not stop the patient from exercising their right to complain… paying money does not waive one’s rights. The aim of a refund is to rapidly defuse a complaint. It is not a concept of paying money to prevent a complaint to, for example, AHPRA.
Does MIPS provide templets for consent forms? Is a signed informed consent required or just informed consent too over the top?
No. Consent is a process, not a piece of paper and you can record consent in your health records even where the consent was obtained verbally.
While cementing the crown, is it acceptable to have a very minor gap between the margin of crown and the tooth margin that can be sealed by the cement?
This is basic prosthodontics. Most cementation agents are soluble in the oral environment. So any cement ‘seal’ will only be temporary. The bottom line is that the impression was inadequate and the crown should be completely remade.
Patient has been advised of periodontal condition and need for treatment; provider does not want to provide treatment that is below standard of care; can patient be dismissed from practice, or is patient signing a refusal of treatment form enough to hold up in court?
If the patient is disagreeable and will not listen or agree to your recommended treatment, then your only option is to record this in your notes. If you can obtain a written refusal of treatment, this may be a worthwhile document but it is still likely that your records would still be a key if any legal action occurred. If the health records clearly demonstrate that the proposed treatment, risks and likely outcome were communicated to the patient and they still refused, then this would likely reflect well on you.