In practical terms it is good policy to take a full medical history every time a patient is examined and the use of a medical history form provides an excellent way of recording this information.

It is important, however, that the patient is not left to complete the medical history form; whoever is carrying out the examination should go through all the questions with the patient to ensure they fully understand them or indeed can actually read.

Such questioning should obviously be carried out in a manner that ensures patient confidentiality. If a practice wishes to become paperless, the medical history form can be scanned onto the computer. The hard copies should then be be shredded or incinerated.

When a patient attends for an appointment as part of a course of treatment, it is always worth checking to ensure they have not started on any medication or have suffered any relevant illnesses since their last visit. Some practices encourage patients to volunteer such information by placing a sign in the waiting room requesting patients to inform their dentist of these types of changes.

Taking a full medical history at each examination can be onerous, but it is certainly worthwhile both to protect the patient and the dentist’s own position. Having a written record of the patient’s medical history, signed by the patient, often affords protection to the dentist – particularly if an allegation is made that he or she had not taken the patient’s medical history into consideration when carrying out treatment, which subsequently resulted in the patient being avoidably harmed.

It is impossible for any professional person to stop every complaint from arising. It is better to adopt a positive state of mind and accept that occasionally you will get a sub-optimal result or that for a variety of reasons (some beyond your control) that the patient is disappointed or unhappy with something that happened during their visit.

By encouraging patients to express themselves as they leave the treatment area you can often get them to tell you what could have been done better from their perspective.

There are many ways of identifying dissatisfaction:

• Prominently displaying your complaints procedure so that patients don’t have to ask for it and encouraging them to share any negative views with appropriate staff
• Train all staff to identify the ‘body language’ associated with dissatisfaction. The aim is to encourage patients to tell you if they have a problem, before they tell someone else
• Comment or feedback cards - usually only completed by patients who are particularly displeased or delighted with service. It is, of course, helpful to collect positive feedback as well as negative and neutral feedback

By handling this issue at a local level it may be possible to contain the issue and prevent it from escalating out of your control. It can also help to avoid the dissatisfied patient from bottling up a store of complaints.

Dental Protection’s Handling Complaints advice booklet offers lots more guidance on this subject. It can be found in the Risk Management section of the website.

Dental Protection looks upon a mentoring role as squarely part of one’s professional activity and consequently it falls under the scope of the professional indemnity provided to members. No additional subscriptions are payable by the mentor unless the member has opted for membership in a non-clinical category which excludes any involvement in the treatment of patients (this would not be considered sufficient to provide indemnity for any work carried out in a mentoring capacity). 

Each practitioner has a duty of care to each and every patient in whose treatment they are involved. This duty of care has an ethical as well as a legal dimension and one should start from the premise that such a duty of care exists, even when one is not treating the patient personally – one should not lose sight of the subtle and indirect relationship with any patients involved under the care of the mentee, and in relation to whom the mentor might be providing advice.

Several brokers and agents offer insurance policies that are backed by Lloyds. This is acceptable but attention should be paid to the €5,000 excess on each claim. 

You might want to consider the best way of ensuring how a patient would receive the full amount of any award if a claim should ever arise. Perhaps you should ask the associate to deposit €5,000 in a trust account as a contingency measure. 

You might also want to consider why this dentist is not with one of the usual defence organisations. It is not inconceivable that the associate has had conditions applied or had possibly been refused by a previous provider.

Although every dentist is responsible for their own acts and omissions, if the associate subsequently leaves the practice it is possible that any complaint about a former associate may become the vicarious responsibility of the practice. In this situation the associate will need to purchase ‘tail-cover’ from the insurer to indemnify against any cases that may come to light after they have left your practice.

Most claims arise some years after the treatment was provided. Unless the associate has access to occurrence-based indemnity, which is provided by your Dental Protection membership, the practice owner will need to protect themselves against any vicarious liability by ensuring that suitable arrangements have been put in place for any period that the associate will be working for you.