The Dentolegal Consultant team at Dental Protection Limited Australia have put together the following FAQs on some dilemmas faced by dental practitioners managing Covid-19 in Australia. This article was written on 31 March 2020, we acknowledge that circumstances may change daily and ask that you regularly check links for up to date information.
I am having to do some remote consultations – is there any advice?
Dental Protection is aware that due to the current situation, members may not be in a position to see their patients at the surgery. The implementation of quarantine or social restriction means that members may be required to carry out remote consultations.
In making the decision to consult remotely, the practitioner must balance the risks and benefits in how they consult with their patients and how they advise them. They must also be satisfied that they can adequately and clinically assess the patient remotely.
Regardless of the unique circumstances, we would recommend members make a record of the reasoning behind any decisions made, and the information given to patients, in case it is necessary to explain the approach taken later.
Please be reassured that should you need to do a remote consultation with a patient whom you would ordinarily see face-to-face but are unable to due to restrictions on practice due to the Covid-19 pandemic, your membership with Dental Protection will enable you to request assistance for matters that could arise from such consultations during this time.
The Dental Board of Australia do not have specific guidance on teledentistry, and so would expect all dental practitioners to work in accordance with the overarching guidance of the code of conduct. This includes patient privacy, obtaining valid consent and, documenting the consultation in your clinical notes. https://www.dentalboard.gov.au/Codes-Guidelines/Policies-Codes-Guidelines/Code-of-conduct.aspx
The RACGP (Royal College of General Practitioners) have a helpful resource for those dental practitioners wanting to better understand how teledentistry could work in their practice https://www.racgp.org.au/running-a-practice/technology/clinical-technology/telehealth/telehealth-video-consultations-guide
Dental Protection has also published COVID-19 and remote consultations – how we can help https://www.dentalprotection.org/australia/publications-resources/dentolegal-articles/articles/aus-covid-19-and-remote-consultations-how-we-can-help
The practice owner is urging me to continue treating patients – where does this leave me?
As a registered dental practitioner you have the personal responsibility of ensuring the safety of your patients and staff, this responsibility cannot be delegated to a practice owner or any other practitioner. We would urge all dental practitioners to be aware of the current guidance. This can be found here: https://www.ahpra.gov.au/News/COVID-19.aspx
What is deemed emergency treatment and should be continued during COVID?
This can also be found in the Dental Board of Australia Guidance: https://www.ahpra.gov.au/News/COVID-19.aspx
I’m worried my working conditions and environment during this crisis may be unsafe - how can I protect my own health, and protect myself from potential errors resulting from these circumstances?
Firstly, employers have a duty of care to all their employees to ensure that the environment is safe to work in, and you should be clear about the actions and procedures that have been put in place to protect staff by your employer.
Your own health is important, and you should ensure that you selfcare in order to protect yourself, your colleagues and your patients.
If you have pre-existing health conditions that place you at increased risk of infection, you should discuss working arrangements with colleagues and your employer. It may be appropriate to ask another suitably qualified colleague to take over the care of patients who are suspected to have, or have been diagnosed as having, COVID-19.
If you are worried that patient safety or care may be compromised as a result of the pressures placed on you or on the practice to continue treating patients amid the COVID-19 crisis, you should raise your concerns with the practice owner and/or employer in the first instance. You should also record any concerns in writing, clearly and objectively setting out the reasons for the concerns and the potential impact on patient safety, with examples.
Keep a record of any correspondence or discussions about the problems you have raised and the steps that you have taken to try to remedy matters. If an adverse incident does occur, it is important to show that you took action.
What should I do if am advised that a patient who attended the practice has tested positive for coronavirus?
It is understandable that healthcare providers – including dental practitioners – will have concerns regarding their own health and the risk of contracting COVID-19 infection.
Please contact the relevant department for your State or Territory to obtain the most up to date advice details of which can be found here: https://www.health.gov.au/about-us/contact-us/local-state-and-territory-health-departments
Given the unprecedented circumstances, are we still required to keep as detailed patient records?
We are in the midst of an unprecedented public health emergency, however, the standard dentolegal advice continues to apply. Dentists must, as usual, adhere to guidelines on record keeping. In addition, we recommend that the clinical records show clearly that the most recent government advice is being followed and, exceptionally if anything differs from it, ensure you have noted all relevant discussions with the patient and explained the rationale behind your clinical decisions.
In the current fast-changing environment, it is essential that dental practitioners keep up to date with the latest governmental guidance.
Some patients are demanding to know what precautions we are taking to prevent the spread of the virus. Are we required to tell them what measures we are taking?
Some patients may be concerned for their welfare and safety and explaining the measures and precautions that you are taking in accordance with the Australian Health Protection Principal Committee guidelines may well address these concerns.