Welcome to our April Newsletter,

It's been a busy start to the year and we would really like to thank you for each and every referral that you sent. Having spent so many years developing and refining their skills all the specialist clinicians at the practice really enjoy being able offer your patients the very best advice and care that they can.

I have had the opportunity recently to listen to Helen Kaney (at our practice round table evening) and Kevin Lewis (at the annual British Society of Prosthodontics meeting) both from Dental Protection. Whilst always a sobering education, there were many very interesting points and lessons. In terms of receiving a fitness to practise letter from the GDC there really is no formula to keeping on the right side.

It appears that complaints have increased by 3-400% in the last few years with few signs of slowing down. It looks like it won't be long before all of us have a story to tell about being on the receiving end of a GDC investigation. When I qualified it was a realistic expectation to practise your whole career without GDC attention. This is no longer the case and most new graduates expect issues. As a result new graduates are very concerned about doing the right thing, so much so that it may hinder their development.

I have really enjoyed the popular psychology books by Malcolm Galdwell, Kevin Lewis reminded us that in one (Blink) Gladwell explains the idea that it takes approximately 10,000 hours to become an expert at anything. This applies equally to a skilled profession as dentistry as much as it does to sports. Importantly just "doing it" is not enough. You need to ensure that your hours are "purposeful practise", meaning that each time you approach something you are planning it before, thinking it through and then critiquing the process and result. For us this is what specialist practise is all about. Each of us have achieved over 10,000 hours purposeful practise in our own area of interest and continue to learn with every case you refer.  Kevin suggested that when you see a skilled person or specialist managing a complex task with apparent ease think not "that looks really easy, I can do that" but instead " oh that's how easy it will look and feel when I have 10,000 hours of purposeful practise."

 In terms of reducing your chances of a complaint the message was not to hide problems or upset your patients - friends rarely complain about friends.

How to manage this has been addressed by dental protection and their view of this is that in the vast majority of cases patients have been "primed" by a failing in your, or the practice, systems. The "relationship" could continue for some time before a "precipitating" factor causes the patient to complain. An estimate is that only about 3% of patients that could complain do. Irrespective of your opinion of the GDC and its actions, we clearly have a long way to go in providing the optimum level of service and care.

Given that problems will always happen the advice is to reduce the chance of a "precipitating factor" causing a complaint by addressing the "predisposing factors" the "predisposing factors" being listed as:

"Rudeness, delays, inattentiveness, miscommunication, apathy, lack of cleanliness, minor system errors."

These do not seem like major issues and they are not, but they are the drivers for the value judgments that patient make about us and collectively influence how a patient may react when something goes wrong. For a full explanation of this please look at the free book on Handling Complaints by Dental Protection.

It also seems that we are hindering the process and making ourselves bigger targets at the same time (not smart); the "Bolan principle" said that in potential negligence cases you needed to show that there was body of opinion that supported your view. For general dentistry this meant that the quality of care you provide should be "acceptable" to the profession rather than "unacceptable"  - seems simple.

Kevin points out that the problem has arisen primarily due to marketing:

 With GDP's advertising widely to attract patients using terms that suggest everything they do is the very best that can be done, companies such as Denplan trying to attract patients with literature promoting the "highest standards" and even the NHS suggesting "best practise" Kevin showed that the level of "unacceptable" care for which we are judged has been raised, which is very bad news when you find yourself in a complaint situation.

Closer to home Dental Protection found that during the economic downturn there was a trend for practitioners to try to do treatment that was at the far end of their skill and knowledge level, rather than to refer the patients. This of course makes sound economic sense but results in many more unhappy and complaining patients.

On a "positive note" whilst dentists are apparently three to four times as likely to be sued in England as anywhere else in the world, this number is slightly lower for Scotland (due to the firm of dentists turned lawyers that work in England, not operating in Scotland) and is reflected in lower indemnity fees.

The level at which specialists are judged is understandably higher, we are judged against other specialists and because our relationships with patients are shorter (Kevin suggested this as "strangers in the night"!) the risk of complaint is significantly higher.

In our situation we acknowledge that we are trying to provide the very best for your patients and are being judged as such against the specialist community as a whole. I think that "purposeful practise" may be our new mantra.

I hope you have a great Easter and a relaxing break if you are taking one,