Saturday, 30 March 2013
I write today to remind colleagues of the need to maintain high quality up to date dental records which in turn will promote high quality referrals and minimise the risk to patients from inaccurate and confusing referrals. Good quality record keeping promotes high standards of communication between colleagues.
I am prompted to do this following the incident reported this month where a patient who suffered four years of agony after a procedure to remove a tooth has accepted £50,000 compensation. Rehana Musa, 72, sued dentist Dr Piotr Pietruszczak after he failed to consult her medical history before pulling out her wisdom tooth in 2008. This led to severe complications due to the wound not healing and indeed Mrs Musa had to have part of her lower jaw removed.
As dentists and responsible health professionals we must do whatever we can to minimise human error and mistakes when we treat patients. Good accurate record keeping is important. Inaccurate and poor record keeping can and indeed does lead to devastating errors.
I am the lead clinician on the Heywood Middleton and Rochdale CATS service, an innovative scheme designed to deliver specialist dental services within a primary care environment and have been leading on this service for the past 8 years. I get referrals from all over the borough of Rochdale from colleagues asking me to undertake surgical procedures on their patients. I have noticed an increasing incidence of poor quality, and inaccurate referrals. Some of them are illegible, some have the wrong tooth to be extracted, say lower left instead of lower right. Often the medical history is incomplete. A complete and accurate medical history is vital bearing in mind the events suffered by Mrs Musa.
Many times pre-operative diagnostic tests such as x-rays of the tooth in question have not been done which sometimes makes me wonder how a referring dentist can have assessed the tooth as being suitable for surgery. On occasions up to 40% of the referrals that I receive are deficient in some way and have to be rejected and returned to the referring practitioner.
In order to improve the quality of record keeping and thereby minimise errors I would always advise the following six key points:
1. Dental records must be easily legible if handwritten and they must be contemporaneous – i.e. they must be written at the time not some hours or days later when one’s memory can cloud recollection of events.
2. Dental records must be of a consistent standard and must state facts and not opinion and must be accurate.
3. Paper records must be kept securely together and have the patient’s name and date of birth on each page.
4. Records must be arranged in chronological order – so one event logically follows another.
5. Records must be regularly audited and benchmarked against recognised national quality standards. I would recommend doing this every quarter.
6. Medical histories must be checked and updated every time a patient visits the practice and any changes noted down immediately.
Ultimately we are responsible for the care of a patient who is putting their trust in our hands. We must do whatever we can to earn and keep that trust. Good, accurate record keeping is an important step along this pathway of trust. Poor quality and inaccurate record keeping can lead to lead to a confusing state of affairs for patients and disastrous consequences.
Friday, 22 March 2013
This month marks my tenth year delivering hands-on oral surgery teaching sessions to dentists. The reflection on this anniversary was prompted by me having conducted my latest hands-on teaching session at Kingsmill Hospital in Mansfield last week.
In 2001 I was appointed as a hospital practitioner in oral surgery at Manchester Dental Hospital. In this role I used to undertake postgraduate teaching and training of dentists in minor oral surgery. In 2003 I teamed up with fellow tutor Javed Ikram to head up and lead postgraduate teaching and training to a wider audience. Javed and I attended the British Dental Association conference in Manchester in 2003. We watched a session called "Hot Tips" in dentistry where speakers from all over the country were given a 10 minute slot in which to impart some special tips and tricks to their colleagues. Javed and I left that conference feeling that we could also do a short 10 minutes slot in oral surgery giving 10 hot tips to dentist within 10 minutes. At the Glasgow conference in 2004 we managed as two speakers on a 10 minute slots to impart 10 hot tips to practitioners in oral surgery within the allotted time frame. I can remember being nervous and reminding both Javed and myself that we had to stick to time rigidly otherwise we would get thrown off the stage!
Following on from that performance we were invited to lecture to the East Midlands deanery at Mansfield in Kingsmill Hospital. This was back in 2004. This was our first opportunity to provide an all day hands on teaching session to colleagues. I remember being excited and humbled at the prospect of teaching and lecturing to my peers. We have now been invited year-on-year since 2003 to Mansfield to lecture and last week we completed our 10th year at Kingsmill Hospital. The fact that we have been asked back year after year is both an honour and a privilege but also hopefully a testament to our abilities as teachers and trainers in this field. In the last few years we have actually been invited twice per year to lecture and teach at Kingsmill such is the demand for our course.
We have also conducted many hands on courses for the North Western Deanery both to general dental practitioners and also to foundation dentists. At the British Dental Association conference in 2005 we were invited to give a lecture in oral surgery. I remember being quite worried because we had drawn the first slot on the Saturday morning which was the morning after the Friday night party. We were absolutely astounded when the hall filled up rapidly and in fact delegates were turned away because the lecture hall was full. At the British Dental Association conference in 2008 we conducted a hands on suturing session which gave dentists the opportunity to practice their suturing skills on dummy models. We have always sought to use a variety of teaching in training techniques always remembering that we are lecturing to our colleagues as frontline dentists who see patients on a day-to-day basis in primary care rather than purely as academics.
As a teacher and educator I think that I have over the past decade taught and mentored over 500 dentists in oral surgery at postgraduate level and has lectured and taught on the subject at regional and national meetings. Recently I was re-selected as a tutor on the Faculty of General Practice Certificate in Minor Oral Surgery course at the Royal College of Surgeons of England in London for the second year in a row.
We need to ensure that general dentists are given enough training to allow them to confidently complete minor oral surgery procedures in practice. It is not just completing the cases that is important - it is the ability to assess what they can and cannot manage in terms of treatment that also determines their competence and ability. Knowing ones limitations is an important part of being a caring, competent and reflective practitioner. Many dentists put themselves forward to study implant based hands on courses yet they are not confident in soft and hard tissue management including extractions and surgical removal of roots. There is also a widespread concern about the lack of experience that new graduates are coming out of university with. Instead of graduating as competent dentists they are now graduating as safe beginners. There is a need for much wider basic and fundamental hands-on training in oral surgery to be available to dentists particularly at the most junior levels. At UCLAN where I am the specialist oral surgery lead at the UCLAN dental clinic are looking to develop a series of short five-week modular courses for dentists who are seeking to gain wide experience and becoming more proficient in their skills. What worries me is not only the lack of confidence and experience among newly qualified graduates, but also among even more senior colleagues and also those graduates from outside the UK.
It seems like only yesterday when we first started doing our hands-on lectures. It really is amazing to think that I am now in my 10th year of doing this. I am humbled to have been given this opportunity over the past decade and look forward to teaching and training for many years to come.
Tuesday, 19 March 2013
Last week marked six months since my appointment as oral surgery specialist to the prestigious University of Lancashire (UCLan) Dental Clinic in Preston. The University of Central Lancashire has created a £1.3m state-of-the art dental clinic at its Preston city campus, which is providing much-needed services for local people as well as staff and students. The clinic has four general dental surgeries; an oral surgery suite (two surgeries and recovery room) and a 10-chair training suite and will be fully equipped to meet both treatment and teaching requirements. UCLan is one of the few universities in the country, other than specialist dedicated medical centres, to have such facilities on site.
I lead the specialist oral surgery services at the UCLan Dental Clinic. I am registered with the General Dental Council as a specialist in Oral Surgery and have responsibility for providing not only treatment to patients but also teaching dentists. Between 2001 and 2009 I was a senior teaching fellow in oral and maxillofacial surgery at Manchester Dental Hospital where I was responsible for the teaching, lecturing and supervision of dentists on the University of Manchester’s Masters program in oral and maxillofacial surgery. Currently I am the clinical Lead for the NHS Heywood, Middleton and Rochdale dental CATS services which since 2010 have been providing specialist oral services out of primary dental practices at Langley Dental Practice, Middleton, Manchester and The Phoenix Centre Heywood.
As a teacher and educator I have over the past decade taught and mentored over 500 dentists in oral surgery at postgraduate level and have lectured and taught on the subject at regional and national meetings. Recently I was selected as a tutor on the Faculty of General Practice Certificate in Minor Oral Surgery course at the Royal College of Surgeons of England in London for the second year in a row.
In terms of UCLan it has been a very exciting and progressive six months. We started out in September 2012 from scratch with no patient base. Over these six months we have built up a steady cohort of patients who are coming to see us both from within the University campus and from outside based on our reputation and recommendation. My position as a specialist oral surgeon means that I get to see some of the more advanced, difficult and complicated cases that are either referred from amongst my own colleagues or from outside from fellow practitioners. I am also involved in teaching dentists at postgraduate level who are undertaking the Masters programme in oral surgery at UCLan.
I have been very excited to be able to work with my first cohort of postgraduates and it has been a very stimulating and interesting experience. They are keen, enthusiastic and very impressed with the high tech, modern teaching facilities that we have here at the clinic. My job is to guide and supervise them whilst they are performing complex cases in oral surgery. I oversee them and am also responsible for their assessment. Teaching and training at this level is so important if we are to create the next generation of specialist practitioners who will take the profession forward.
We need to ensure that general dentists are given enough training to allow them to confidently complete minor oral surgery procedures in practice. It is not just completing the cases that is important – it is the ability to assess what they can and cannot manage in terms of treatment that also determines their competence and ability. Knowing ones limitations is an important part of being a caring, competent and reflective practitioner. Whilst many dentists put themselves forward to study implant based hands on courses many of them are not confident in soft and hard tissue management including extractions and surgical removal of roots. The rigours of a Masters programme is a rewarding challenge for those dentists who are seeking to gain experience and a formal university level qualification in oral surgery in practice whilst still being able to continue to work.
In terms of dentistry UCLan is one of the most progressive and forward thinking institutions in the country. The clinic itself is one of the most exciting and groundbreaking dental ventures of the past 12 months. The staff who work there are of the highest quality and well respected in their specialist fields. I am confident that the next six months will see a widening of our patient base and an increase in the uptake of oral surgery services. So far it has been a wonderful first six months and I am looking forward to helping this clinic go from strength to strength.
Saturday, 9 March 2013
I am pleased to report that once again I have again been selected as a tutor on the Faculty of General Practice Certificate in Minor Oral Surgery course at the Royal College of Surgeons of England in London. This will be the second year in a row that I has been selected as a tutor on this prestigious course. This is on top of being the oral surgery clinical lead for the NHS Heywood Middleton and Rochdale CATS scheme which is an innovative, pioneering referral based scheme designed to bring specialist oral and dental surgical care closer to communities in Middleton, Heywood and Rochdale in Greater Manchester, as well as the staff specialist in oral surgery at the UCLAN dental clinic in Preston. I have a passionate commitment to dental postgraduate education having been a trainer for vocational trainees (new dental graduates) between 2005 and 2009 and having taught on the Masters programme in oral surgery at Manchester and now at UCLAN.
I am thrilled and honoured to be working with the Faculty of General Practice at the Royal College of Surgeons once again. The certificate course in oral surgery is a superb hands on way for general dental practitioners to increase their confidence and experience in minor oral surgery. The fundamental aim of this course is to provide the dentists with an opportunity to complete multiple “hands on” oral surgery cases supervised by a specialist oral surgeon within a primary care setting or specialist minor oral surgery clinic. The theoretical part is delivered at the Royal College of Surgeons in London and the practical sessions are delivered regionally by tutors. Last year after a competitive selection process I was delighted to be selected as a tutor and I am even more thrilled to be selected again as a tutor for the new cohort of dentists who have commenced this month on this year long course.
We need to ensure that general dentists are given enough training to allow them to confidently complete minor oral surgery procedures in practice. It is not just completing the cases that is important – it is the ability to assess what they can and cannot manage in terms of treatment that also determines their competence and ability. Knowing ones limitations is an important part of being a caring, competent and reflective practitioner. Whilst many dentists put themselves forward to study implant based hands on courses many of them are not confident in soft and hard tissue management including extractions and surgical removal of roots. There aren’t many courses out there that provide the chance for the busy general dental practitioner to gain experience in carrying out hands on minor oral surgery in practice whilst still being able to continue to work. Dental schools are no longer sending out qualified dentists – they are sending “safe beginners” in to the world. The surgical removal of teeth has been identified as one of the areas that newly qualified dentists feel least prepared for after their university training has been completed. Unfortunately the effect of this is that many minor oral surgery cases which could be seen in practice are referred to hospital secondary care facilities which takes away valuable resources that perhaps could have been treated in the primary care sector. The dental schools have abdicated their responsibility for producing skilled practical dentists and they argue that the world has changed from the past say 25 plus years ago when I qualified. However although the world has changed dentists are still hands on people who need to deliver practical hands on care. Regrettably nobody at either dental schools or anywhere else amongst the powers that be are willing to listen – they continue to agree amongst themselves that all is well. Yet those of us that come across new dental graduates see a different picture. To speak out against this self perpetuating elite is indeed heresy.
The Faculty of General Dental Practice at the Royal College of Surgeons is a very prestigious organisation. It was formed over 20 years ago as the academic home for general dental practitioners and aims to improve the standard of care delivered to patients through standard setting, postgraduate training and assessment, education and research. To be working with such an auspicious body on one of their courses is indeed an honour