The following case is fictitious but based on the types of calls we receive to the DDU advice line.

The scene

Six weeks before her call, a DDU associate dentist member had seen a patient who had attended in pain from his UL5. She took a radiograph and noted a periapical lesion, for which the tooth required either root canal treatment or extraction.

She found no signs of spreading infection, and the patient did not have a temperature. However, she was running late for her daughter' parents' evening, and so rather than taking the time to establish drainage, she decided to prescribe amoxicillin and asked the patient to re-book for further treatment, in the knowledge that he was going abroad the next day on holiday.

Some days later, the patient contacted the practice saying he'd had to fly home early from his holiday because of a significant allergic reaction to the antibiotics, with a very nasty rash. He subsequently made a formal complaint to the practice.

Our member's employer told her that they would draft her response, but that while she could review it, they would not allow her to make any concessions or admit that a mistake had been made.

In the response, the employer stated that it had been entirely appropriate to prescribe antibiotics and that the patient had presented with a spreading infection and temperature.

She was understandably and justifiably anxious about this and contacted the DDU's advice line for help.

Our advice

The DDU adviser discussed with our member her duty of candour, and the fact that she should not be pressurised by her employer to act in a way that contravened that. She advised her too that she should not allow her employer to say anything in the letter that contradicted the clinical records.

She was also reminded of the GDC's duty of candour guidance, which, in line with the Standards, confirms that, "Every healthcare professional must be open and honest with patients when something goes wrong with their treatment or care which causes, or has the potential to cause, harm or distress."

Our member was concerned that her employer might not be willing to accept this, so the adviser suggested that she might explain to the employer that not only was it important she adhere to the GDC's guidance, but that being entirely open and honest was likely to be the best approach for both the patient and the practice, in that it would promote a culture of mutual trust and respect in patients.

Because this complaint could escalate, the dentist was advised to undertake some relevant CPD, both in relation to antibiotic prescribing and duty of candour. This could then be disclosed in due course if required.