Even the most experienced dentists will occasionally come across situations that seem unique and difficult to manage. These instances are of course more common for those who are newly qualified, and may include clinical situations as well as dento-legal challenges, such as those involved in managing vulnerable patients.
No matter how much experience we have, however, it is wise to stay familiar with current standards and guidance in these areas, so we can help our patients in the appropriate way.
The following case study illustrates some of these challenges:
A 15-year old patient and his mother attended an examination with a newly qualified dentist. During the appointment the dentist noticed scars on the patient's forearms. When asked, the patient said he had been self-harming and gave the dentist permission to speak to his mother about it.
When the dentist did so, the patient's mother became very upset, saying she sometimes feared for her own safety because the patient's behaviour was erratic and he sometimes became violent at home.
After taking advice from the DDU, the dentist reported the discussions to the safeguarding lead at the practice, who in turn reported the concerns to social services. Social services confirmed that the family were known to them already, but said they would provide extra support for the family due to the violent behaviour of the teenage child.
All GDC registrants must protect the confidentiality of patients' information and only use it for the purpose for which it was given. In this example, the dentist acted correctly by asking the patient's permission to discuss his self-harming with his mother.
In general, all patients - including those under 16 who are deemed mature enough to make decisions about their care - should be asked for permission to share their information. However, in exceptional circumstances you may be justified in discussing confidential information about a patient with others, if doing so is in the best interests of the public or the patient.
If you believe a patient is putting their own safety or that of others at serious risk you can break confidentiality, even if a patient declines to give you their consent. You should normally tell the patient that you're going to do this, unless you think this information is likely to lead to the patient suffering harm. Make sure you clearly record the relevant discussions you have with the patient, and your justification for breaking patient confidentiality, in the clinical notes.
Every practice should have a safeguarding policy in place to help protect children and vulnerable adults. There should also be a safeguarding lead within the practice, who is the person responsible for making sure the safeguarding policy is adhered to.
If faced with a situation where you have concerns for a vulnerable person, you should notify the practice's safeguarding lead and check your concern has been properly actioned.
Unfortunately, instances of abuse and neglect are more common than we may think. As health professionals we have an important role to play in safeguarding children and vulnerable adults, and we should be able to recognise potential signs and have the courage to ask questions when we do.
If you have concerns for the safety of your patients or others, raise those concerns with the appropriate person, even if the patient declines to give their permission to do so.