Risk management in general dental practice

  • R. Rattan &
  • J. Tiernan
Surrey: Quintessence, 2004 price £28, pp154 ISBN 1850970661 | ISBN: 1-850-97066-1

As part of the highly successful Quintessentials of dental practice series, this book aims to give GDPs an informative overview of a subject in a short space of time. It is quite surprising just how much information has been packed into this A5 book — which can be read from cover to cover in just a few hours.

Risk management in healthcare is a relatively new phenomenon; it has become increasingly common due to the attempt — by the NHS in particular — to contain spiralling litigation costs against doctors and trusts. This is a timely addition to the oeuvre from a general dental practice perspective, combining the theory of risk management with the practicalities of introducing workable systems into your practice.

The 10 chapters, written by two well respected dento-legal writers and lecturers, cover: the basics of understanding risk and risk management; ethical considerations; and the application of these theories to areas of general practice where problems occur with unerring frequency. These areas are consent, the dentist-patient relationship, clinical records, clinical negligence, handling complaints and the more general concepts of business risk.

Risk is defined early on as: 'The probability that a hazard will give rise to harm. It is not the same as uncertainty. Risk is when you do not know what will happen but you do know the probabilities; uncertainty is when you do not even know the probabilities'. Risk management therefore is rooted in the mathematics of probability but set against a background of a decision making process 'amidst uncertainty'.

We live and work in an environment where a potent cocktail of high patient expectations and easily accessible litigation services make identifying areas of risk an important consideration. The fact that a failure in patient communication is the predominant factor in patient complaints and litigation in 80% of cases means the advice in the chapter on this subject alone warrants the cover price.

The book contains very good practical advice; the chapter on dentist-patient relationships goes into great detail about the types of patients and the associated risks that accompany red flag patients — which acts as a reminder to all practitioners to be aware of the emotional baggage that some patients carry. The bottom line with risk management however is that 'like it or not, it is inevitable it generates paper trails, documentation is an important part of the process'. This is emphasised in the chapters on consent and clinical records as well as clinical negligence.

Entire books have been written on the subject of clinical negligence so a 12-page synopsis could not hope to cover this vast and ever changing subject. Instead it gives some essential points with an indication of the high risk areas and common drivers of litigation, and some practical tips on reducing a practice's exposure to risk.

I was particularly intrigued by the chaos theory that the author expounds with reference to Spielberg and Crichton's Jurassic Park... The small investment in buying, reading and implementing even 50% of what this book advocates could save you from the consequences of making mistakes and avoiding complaints.