Noel Kavanagh explores the challenges and risks in the early days of a typical dentist’s career and offers advice on risk management strategies.
Qualifying from dental school is a significant event in any new graduate’s life. It is a new chapter, the beginning of a professional career that one may have dreamt of for a long time. After the euphoria of getting through your finals, there are probably some important questions to consider before you make any decisions about your future career.
There are differences between working in a small practice that offers general dentistry and working in a large practice with both generalists and specialists on-site. The multi-disciplinary environment potentially offers a different experience as you will be able to gain an insight into the world of specialist dentistry.
Clinical decision-making and treatment planning without a tutor peering over your shoulder can feel quite liberating at first, but it can also be daunting and lead to self-doubt. In a dental school environment, you are used to having treatment plans scrutinised and approved by clinical supervisors.
Now, you are charged with the responsibility of your patient’s safety and welfare; it can be a little nerve-wrecking and it takes time before you feel confident and comfortable in the role. It is at this point that you would see the benefit of working alongside supportive colleagues.
Having the ability to knock on the surgery next door and run a treatment plan or radiograph by a colleague can prove invaluable. Having senior colleagues available to assist you with a difficult extraction, or support you with a challenging patient, is a benefit not to be overlooked.
The business side of dentistry
It is prudent from the outset to clarify and understand the business expectations of the dental practice that you work for. Some new graduates may inadvertently find themselves in a situation where there is pressure to hit certain financial targets or other Key Performance Indicators (KPIs).
KPIs and other metrics are an integral part of practice management, but they should not become targets. If they do, then they could potentially drive the wrong behaviours and herein lies the risk. If combined with a low associate percentage or a sliding scale of remuneration, the consequence may be the temptation or pressure to carry out more ‘high value treatments’ such as implants, cosmetic dentistry or short-term orthodontics without the requisite training and experience.
Before your first day
It is important to orientate yourself with the practice policies and procedures ahead of your first day of seeing patients. Do you understand the practice procedure for dealing with a medical emergency? Where are the emergency drugs kept? What is the practice complaints procedure? What fee structure is applied to patient care? These are all questions that should form the basis of your induction, before you greet your first patient. It may be helpful to have a list of questions for your new colleagues to ensure you have all the information you need to start delivering safe care from the outset.
One of the biggest changes from dental school, or indeed moving practices, can be the changes to dental materials, instruments, laboratories, and local referral routes. It is quite possible that you will be using a new software package for your clinical records and/or radiographs and having the ability to orientate yourself to the new systems ahead of your first day can help ease the pressure, as you get to grips with your new surroundings. Similarly, dental materials may differ and taking the time to understand the manufacturer’s instructions of use for common materials will save you time and stress when you first come to use a particular material.
Getting to know your (new) patients
The biggest shift when starting out in a new practice is getting to know a new group of patients. Your patients may come with existing expectations based on previous interactions with colleagues at the practice. Taking time to get to know your patients is key to providing excellent care. It has often been said that a poor clinician who is a good communicator has fewer problems than a good clinician with poor communication skills.
Dental Protection often see complaints that relate not to the specific treatment provided, but rather failure in communication leading to a breakdown in the professional relationship between the dentist and the patient.
There may be concerns that informed consent was not obtained, treatment charges were unclear or that the patient perceives their care was rushed or uncaring. Taking time from the outset to build up rapport with your new patient can pay dividends in the long run.
Dental Protection offers a range of communication skills training courses including some on navigating adverse outcomes, reducing dentolegal risk; these are available at no extra cost as a benefit of membership.
Dentolegal risks
New graduates can sometimes be asked to provide treatments outside their confidence or competence – either by patients or colleagues within the practice. A central pillar in clinical risk management, is recognising and working within your clinical competence. This requires a certain level of personal insight and emotional intelligence.
According to the GDC’s Standards for the Dental Team guidelines, “7.2.2 You should only deliver treatment and care if you are confident that you have had the necessary training and are competent to do so. If you are not confident to provide treatment, you must refer the patient to an appropriately trained colleague.”
The oft quoted Dunning-Kruger Effect is just one example of a cognitive bias that affects our perception of the world around us, causing people to believe that they are more capable than they really are, and they do not yet have the knowledge, experience and understanding to recognise their own incompetence. There is absolutely no substitute for knowledge. Confucius once said that “real knowledge is to know the extent of one’s ignorance.”
Consider starting out with the more ‘straightforward’ cases and build up your skills over time while having the support of a clinical mentor.
It is important to garner knowledge and it may be worth considering the benefits of further educational opportunities and availing of high-quality accredited courses for the more complex treatments.
Wellbeing
It is not unusual for you to feel overwhelmed with work. Having a support network around you will be key to helping you to decompress after a challenging day in the surgery. Attendance at professional networking events can provide an excellent opportunity to meet colleagues from across the profession and to build your network in a relaxed and supportive environment.
Finally, have the courage to reach out for help if you are finding your journey stressful or find yourself in need of someone to talk to. Dental Protection operates a dentolegal advice line which is available 24/7. You may also wish to have a look at the range of well-being resources available on the website.