Hey everyone, I'm Prateek and in this video we're going to be looking at a clinical governance
scenario which hopefully should help you practice for your dental foundation and
dental core training interviews. If you want to see more educational videos like this, please make sure
to subscribe to the channel. The scenario that we're looking at in this video is the following:
'A patient attends complaining of pain from an upper right tooth. On reading his records, you
note that he has a carious upper right seven which was due for treatment by your colleague. For some
reason, the treatment was not completed and the patient was not provided any future appointments.
Discuss how you would manage this case'. So in this video, we're treating this as a clinical governance
scenario, however it could also be treated as a clinical communication or a normal clinical
scenario for dental core training so you can practice it in any of the following forms. As
I've previously discussed, I like to divide these scenarios into three parts. First, we want to look
at the standards that are affected. We then want to look at the short-term management and we then
want to follow this by looking at the long-term management. So broadly speaking we're dealing here
with a patient who has had incomplete treatment. The GDC standards that are affected in virtually
every situation, the first standard working in the patient's best interest and safety is affected
because the patient has had potentially incomplete treatment. Here we need to make sure we're making
the right decisions for the patient. The patient is also in pain so we need to make sure we're
getting them out of pain. We then also need to make sure we communicate effectively with the patient.
We need to make sure they understand what's happening and hopefully we bridge any gaps
from the previous treatment that was carried out, to defuse any potential unpleasant situations. It
is a sensitive topic with this patient and so we need to make sure that we mitigate any potential
issues that may arise. This leads on to the next standard that we have to consider which is
complaints having a clear and effective complaints procedure. This patient, because they have had
incomplete treatment, may want to subsequently complain so we need to be aware of this.
We also have to consider standard eight, which is raising concerns. We've got a colleague who may not
be carrying out appropriate treatment and so this is another red flag that we need to consider when
we're answering this scenario. Is there something else that needs to be investigated and we'll deal
with this later on in the scenario. Other general things that we need to discuss - potential claims of
clinical negligence. So this is something you may want to talk about, clinical competency of your
colleague and also just to tie it in you may want to mention clinical governance and factors such
as auditing and record-keeping. Let's look at the short-term management. So the first aspect is that
we need to explain the patient's dental situation to them. We need to make sure they understand why
they're in pain and how we're going to try and manage this. This is the priority if we think
about the first standard. Following this, we then need to listen to the patient's concerns so they
may be unhappy that treatment wasn't completed, that they were missed in terms of their diary and
they weren't given another appointment. We need to listen to these concerns and try to reassure them
or apologise if necessary. We then need to get the patient out of pain - this is the priority whether
they want to complain or not, whether they want to discuss anything else or not. Our priority is to get
the patient out of pain - so this may be giving pain relief, it may be accessing and dressing a tooth, it
maybe taking the tooth out. Whatever we can decide on mutually with the patient that's what we want
to carry out. We then also want to make sure that the patient is provided adequate long-term care
so stating to them that you're going to follow it up, you're going to make sure they're booked in
then and there for any further treatment that may be necessary. This helps show that you're trying to
avoid the same mistake happening again. If you feel you can't carry out the treatment then you may
want to refer them to a colleague so again this is something that you'd mention to the patient.
The patient may state they want to complain and so we'd want to talk to them about the complaints
procedure and the practice or the hospital will have a clear and effective complaint procedure
in place so the patient needs to be referred to this. Following on from this, we then have
three standard things that you'd want to consider in any scenario. The first one you would want to
speak to your supervisor - so discuss the case with the supervisor make sure that you are happy with
what you've done and they're happy with what you've done. It may be that you actually want to
get them in when the patient is there or it may be something that you're relatively comfortable
with handling but you want to get them in later on or have a chat with them later on. Following
this you also want to speak to an indemnity provider. Although you may have done everything
within your power you want to make sure you're covered in all ways so you may want to give your
indemnity provider a call and see what they think about the situation and you then want to keep
clear concise and contemporaneous notes. Document everything that's been done in this appointment.
Make sure you've documented all your actions and the patient's responses to this as well.
So that if anything does come from this scenario, you've got everything documented clearly. This
looks at the short-term management, let's now look at the longer-term management for this patient.
Carrying on from what I mentioned earlier, we want to ensure the patient gets the appropriate
care. So we need to make sure they're followed up properly. We need to make sure that their pain has
been settled and any other follow-up telephone calls, reviews, anything that needs to be done
is in the diary so that the patient doesn't go through any further problems. Additionally,
if they have put a complaint in, we need to make sure that this is followed up according to the
practice's complaints policy because we don't want to miss this off. We also want to discuss this case
with the colleague. It'd be worth if you're not comfortable with it your supervisor doing it or
you're doing it collectively to understand was this a one-off incident in which case we just
need to be aware of what's happened or is it a recurring pattern that needs further investigating.
Team meetings may be necessary if it's a one-off because we may want to look at how we can avoid
this happening again - so do we need to have more robust booking in systems? Do we need to ensure
that follow-ups are checked? Anything like that - so getting the entire team involved. We may also
want to audit and look at missed appointments to ensure that we don't have any of these happening
elsewhere because there may be other patients that have had the same situation but just
haven't experienced any pain yet. If you find that this is a recurring pattern, you may then want to
raise concerns and escalate as necessary so as a dental core trainee or foundation dentist you
may feel out of your depth doing this so your supervisor may be more responsible for this.
But it would be a case of looking at things like negligence and escalating as necessary so ideally
within your practice your practice manager may want to speak to the colleague to make sure that
this doesn't happen again or gradually it would get escalated but ultimately ending up at a GDC
fitness to practice hearing. We may also want to just do general CPD so we may all want to learn
from the situation. If it's treatment related if we want to do some further CPD regarding
the treatment or your colleague may want to do this if they weren't happy doing the treatment
that was put in front of them. And finally you want to reflect on the situation and document
this in your portfolio. This would be reflecting on the appointment but also the follow-up - how
your colleague was handled, how you communicate with your supervisor and what you can learn from
this. So there we've looked at the standards, we've looked at the short-term management and
we've looked at the long-term management of this situation in order to try and maximise what we can
get from answering this type of station. I hope you found that useful. My recommendation in this video
is another YouTuber - Yewande. Now she has done a huge number of videos on progressing through dental
school, some of the challenges along the way and now she's currently doing her foundation dentistry
and is documenting this. I strongly suggest you check out the channel for a bit more information.
So I hope you found this video useful. If you did make sure you like, comment and subscribe
and let me know of any of the videos that you'd like me to do. Until the next video - take care!