Hi I'm Prateek and in this video we're going to be looking at another scenario
to help you prepare for your dental core training or foundation dentistry interviews.
If you want to see more educational videos and get some tips on applications then please make sure to
subscribe to the channel. So we'll be focusing on a clinical governance scenario in this video
and the scenario is as follows: 'You reach work at 8am and meet one of the other dentists. There
is a strong smell of alcohol coming from them and they appear to stumble a little. How would
you handle this situation?'. If you've not looked at the other videos relating to scenarios and dental
core training interviews, then please make sure that you do because it'll give you some helpful
tips on how to structure your answer. For those of you who have seen those videos you'll know that
I like to structure my answer in three parts. So firstly looking at the GDC standards and clinical
governance issues that are affected in this scenario. Then looking at the short-term management
and finally looking at the long-term management - so let's get straight into it. So firstly let's
look at the GDC standards that are impacted in this scenario. Standard one is putting the
patient's best interests first. This is extremely important - we have a suspicion that our colleague
may be drunk and this will therefore impact the treatment that is carried out on patients.
Next, we need to consider standard two which is communicating effectively with patients. This is
quite a sensitive matter and patients may require their appointments to be cancelled or rescheduled
or moved to another dentist and so we have to be careful with how you communicate this to patients.
We can also consider standard five - having a clear and effective complaints procedure.
Some patients may be inconvenienced by appointments being cancelled and so they may
want to put a complaint into the practice so we have to bring this into play as well. Standard six
which is working with the team is also important because we're going to need multiple members of
the team to pull together to help organise, move patients around, handle your colleague and so it's
important that we work effectively within the team as well. From a personal point of view, you can also
consider standard seven maintaining developing and working within your own professional skills
and knowledge. This may not be a situation as a foundation dentist or a dental core trainee
that you've experienced before and so you may have to call upon a senior individual, a supervisor to
help handle the scenario. Then probably the most important in this scenario is standard eight
raising concerns. We have a colleague again who is drunk or potentially drunk and therefore are we
concerned that they are doing this on a regular basis, is this then going to be impacting patients
and so we have to consider do we need to escalate this any further. And finally standard nine which
is protecting the confidence in the profession. If word got out that your colleague is drunk turning
up to work, this doesn't reflect well on the dental profession and therefore we also need to address
this. Let's now look at the short-term management. First and foremost, if we feel comfortable we
should speak to the colleague and understand the background and the facts. It's very important
that we don't jump to conclusions here. It may be that there's something else going on and we need
to understand the facts before we start making accusations or starting putting out anything else
into play. Does the colleague know that this isn't appropriate? I know it sounds like a silly thing
but it's important that we establish this but most importantly is your colleague actually drunk? Is
there another reason to explain their stumbling or is there another reason to explain the smell
of alcohol on their breath? Alternatively, if you aren't comfortable speaking to the colleague,
then you may need to speak to your supervisor and they can then speak to your colleagues. So
whichever way, you are actually doing something about the situation and that's really important.
The next thing, making the assumption that your colleague is actually drunk, we need to ensure that
the colleague gets home safely so this may be that a member of staff drops them home or we arrange a
taxi for them to get home. It's important that they aren't going and treating patients that's really
important in terms of their best interests but we need to still make sure that they go home safely
and they get home in one piece. The next step once you manage the colleague and you can get them home
is to manage their clinic list so they may have a fully booked day. Patients may have already started
turning up we need to address how we're going to manage these patients and this is where working
within the team becomes really important. So a few scenarios we could potentially cancel the entire
list for that dentist for the day. This obviously inconveniences a lot of patients, some patients may
have attended and we have to send them home. We also have to then reschedule these appointments
but that's one potential option. Another option may be that we see the patients who have turned up - it
may mean that we run slightly late between us but we see the ones that have turned up and we cancel
other patients for the day. Through discussion with the team you may also decide between you
all to see all of the day's patients and fit them into gaps - move them around a little bit so that
appointments aren't being cancelled and patients aren't being inconvenienced by this. Another
potential alternative is seeing if you can get a locum dentist at short notice to come in just
for the day to handle this clinic list. Depending on which option you go for as a practice, there may
be some patients that are unhappy. You may have a patient who's had their appointment cancelled for
the third time and so they may be very angry and so they may want to complain and this is where you
bring in having a clear and effective complaints procedure and we can direct them to this if
necessary. And finally those key things that we can say in any scenario. We may want to discuss
this situation with our indemnity provider. Make sure we've handled everything appropriately, we
haven't missed anything, we haven't left any loose ends. And we want to document clear, contemporaneous
and concise records and notes on these so for example, if an appointment has been cancelled in
the patient's records, we need to explain what's happened and that some further management has
been taken care of. Additionally, if there are any patients that complain we need to make sure that
this is recorded in their notes as well so we're keeping clear documentation of how the situation
has been managed. Let's now look at the long-term management. The big aspect of long-term management
in this case is addressing the dentist and ensuring that this doesn't happen again. So
firstly, we need to have further discussions with this dentist and we need to understand
why they turned up to work drunk. It could be that the dentist is quite stressed, they're
having a lot going on in life at this point in time and so they've turned to alcohol. If this
is the case, again we can't judge, we can't jump to conclusions but we need to support our colleague.
This may be that we help them by signposting them to groups that may help, signposting them to their GP,
other methods of managing their problems in life. However, on the flip side, if your colleague is
completely oblivious to the nature of their actions and that they were inappropriate and
they intend on doing it again, they don't have a reason for what has happened, then this is a
serious cause for concern. It's something that will need escalating locally first, maybe through
the practice manager, who would then have to have a meeting, then regionally and potentially ultimately
ending up to a GDC fitness to practice hearing. As this is significant concern for the profession and
also for the care of patients. Then depending on what happens with this colleague we need to
ensure we've arranged appropriate cover and care for the patients that the colleague was seeing. So
either the patients previously that were cancelled, we need to ensure that they've been rebooked
appropriately and they have care as necessary and if your colleague is needing to take more time off
work to manage whatever stresses are going on in their life then we need to arrange some cover for
their clinic. So this maybe we split it amongst the colleagues or alternatively we need to hire
another dentist for a short period of time to manage this clinic list. Again ultimately we need
to make sure patients aren't being affected by this. There may be some complaints that come in.
These need to be handled, followed up appropriately based on the practice policy as well as
speaking to other members of the staff to try and mitigate any future complaints and team meetings
may be necessary. This may be a good opportunity to check for any issues regarding complaints handling.
If there are any issues in terms of organisation on the day that this happened then we can iron
this out within the team we also may need to fill an incident form based on what happened but this
is something that the practice manager would be instrumental in doing. So again even in the
long-term we're looking at utilising the entire team for this. So on a personal level you need
to ensure that you do some CPD on any areas that you are unsure of so for example, if you don't know
what the complaints handling policy is you need to ensure that you look at this, if you don't know how
escalation works for fitness to practice issues then you need to also look at this. And then this
will feed into your portfolio and reflecting on the situation that happened. You may have a meeting
with your supervisor and have a chat with them - was the situation handled appropriately or do you need
to do some further understanding, further knowledge on the situation? So there we've looked at the
three parts of this scenario. We've looked at the GDC standards and clinical governance issues,
we've looked at the short-term management and we've looked at the long-term management
to hopefully give you a well-structured and well-rounded answer. The recommendation I'd like
to give in this video is the surgical eLogbook particularly for those who are doing MaxFacs
DCT jobs. It's really helpful to have the logbook to keep track of all the procedures that you do
even if you're assisting them or you have someone else helping you then make sure you log these
because it's useful whether you go to specialty training or for future demonstration of experience.
You can also get this as an app on your phone so whilst you're at work you can very easily put the
details on. I hope you found this video useful. Please remember to like, comment and subscribe.
If you do want any of the videos please let me know - until the next video, take care!