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Dentists Who Invest

Podcast Episode

Dr James: 

Fans of the Dentists Who Invest podcast. If you feel like there was one particular episode in the back catalog in the anthology of Dentists Who Invest podcast episodes that really, really, really was massively valuable to you, feel free to share that with a fellow dental colleague who’s in a similar position, so their understanding of finance can be elevated and they can hit the next level of financial success in their life. Also, as well as that, if you could take two seconds to rate and review this podcast, it would mean the world. To me, what that would mean is that it drives this podcast further in terms of reach so that more dentists across the world can be able to benefit from the knowledge contained therein. Welcome.

Louisa: 

Welcome to the Dentists Who Invest podcast. This vlog is made for information purposes only. The views expressed in it are those of the speakers. The contents do not constitute legal advice and should not be relied on as such. The speakers accept no responsibility for the continuing accuracy of the contents.

Dr James: 

Welcome everyone to another episode of Dentists Who Invest official podcast, episode number 30. We’re on now. This is an episode that I’ve wanted to do for quite a long time. It’s something that I feel is relevant to all of us and we don’t necessarily get any formal training on. I want to talk about note writing, contemporaneous note writing, how we can do it better, and I know for a fact I can’t be doing this to the best standard that I can be, because all I’ve got, all the information I’ve got at my end, is hearsay and secondhand accounts from other people about what we should put in our notes, and maybe I’ve never really had any formal training on that. This is why I wanted to create this episode, because I can’t be the only one who feels that way that maybe I’m just putting stuff in there that I would guess or expect is important, but I don’t actually know any better, and this is why I’ve reached out to Louisa Sherlock, who is a lawyer and also formally a dentist. So if there’s anybody who’s uniquely placed to be able to give us a good answer on that question, louisa is Louisa. Welcome to the show.

Speaker 2: 

Thank you. Thank you for inviting me.

Dr James: 

My absolute pleasure, louisa. I feel like I’m going to learn a lot this episode and I think this is going to be very useful to everybody who’s listening because, like I say, no formal training and Louisa and I were talking a little bit off-camera and we were trying to decide what we should put in this episode and there really is so many facets to this. I think we could easily get about three or four episodes out of this about different aspects of the litigation, progress, etc. Etc. So we’re going to keep this episode really focused today on what we should be putting in our notes. Maybe a little bit about what to expect if that, if we ever run a fall of that system and for whatever reason, we are placed in that position where we have to go through litigation fingers crossed none of us ever do, but it does happen. Maybe we will touch upon that very briefly but, as I say, very focused on record keeping and notes today. Louisa, for anybody who doesn’t know you, would you like to do a brief introduction, maybe speak a little bit about your history in dentistry and also what made you take the leap into being a lawyer, and a little bit about your practice, whatever you like, really.

Speaker 2: 

Yeah, well, I was a dental surgeon for over a decade, both in NHS and private practice. I’m now a barrister at number five chambers and also a qualified mediator. As a dentist, I helped to run a very busy NHS practice, helping staff to prepare for CQC inspections and so on. I was also a member of my local dental committee, assisting dentists then who were having difficulties as a barrister. I now practice in clinical negligence, representing both claimant and defendants. I work in personal injury and also commercial and contractual disputes, particularly those involving medical professionals and dentists, as I’m also a mediator and that means that I can go in and act as a neutral third party, helping parties to resolve disputes before they get caught. To answer your question about what made me leave dentistry, well, I’ve always been interested in law. I did a careers test in sixth form actually and the result came out that I should be a barrister, but I was studying sciences. I’d always enjoyed sciences and decided to pursue the route of becoming a dentist because I wanted to care for others. I did enjoy my career as a dentist. I did further training with the Royal College of Surgeons and an Aspectic training course, and I developed a private practice focusing on aesthetic dentistry and invisual orthodontics, as well as some facial aesthetics. However, I’ve always really enjoyed academic work reading, researching and so on so I spent some time with solicitors and barristers observing what they do, and then I decided I definitely wanted to become a barrister. So I commenced the GDL, which is a law conversion course and it’s a three-year law degree converted into one. It’s very intense. I did it full-time, but I still worked part-time in the private practice doing some, spending some hours treating patients and also doing some on-course and emergencies. When I was doing the GDL, I became involved with meeting, which is a sort of advocacy training where you run mock trials and you’re in court as if it’s a real trial. You have competitions. I just really enjoyed that. When a couple of competitions and decided I was even more certain that I wanted to become a barrister, and so I commenced the bar training course, qualified as a barrister, I was called to the bar in 2018 and here I am, three years into my career as a barrister.

Dr James: 

Awesome, wow, and we were saying, as well off camera, there can’t be too many dentists, cum lawyers, people who have done sort of both. Really, I mean you must be there, can’t be too many of you, because it’s quite intense. I’ve had friends who have went through that one-year law conversion course and it was just basically I didn’t see them for a whole year because they just had so much work to do and you’ve managed to do that and do a job around it. It’s a lot to take on and that must be a massive barrier.

Speaker 2: 

Yeah, yes, it’s an awful lot to take on. I think you have to be really certain that it is what you want to do. It is very intense but, as I say, I really enjoy reading, researching, all of that sort of thing. So for me it was a great challenge and I love how it is a barrister. Yeah, definitely worth it.

Dr James: 

As long as you can say that wonderful, wonderful, cool, and you basically the main reason that you wanted to get into it was did you ever fall out of love with dentistry, or was it less? That was it? Maybe you feel like you were more suited, your skills were more useful in a law setting, or what was that moment that made you say, actually, I’m going to do this, I’m going to take the plunge.

Speaker 2: 

I think it was kind of a really gradual process, just having always been interested in law, doing work for the local dental committee, spending time with solicitors and barresters, and I just kind of gradually sort of shifted my views to thinking I feel like this is what I want to do and I don’t think it was necessary falling out of love with dentistry so much, just thinking I feel like I should be going in this direction, becoming a barrister and being able to help dentists in that respect.

Dr James: 

Awesome, cool, yeah. So, as we know, this page is mainly about investing, but to save money to invest, you need to have it in the first place and you need to make sure your notes are in order and you’re as litigation proof as possible. Let’s cut straight to the chase. Louisa, dentists live in fear of being sued and it’s maybe something I don’t know if it’s like a hysteria to a degree, because perpetually it’s something that’s in the back of a lot of our minds and I wanted to know how much we should actually be conscious of this and how much we should be worrying about it. How frequent is it in your experience?

Speaker 2: 

I suppose. I mean you see cases all the time, new cases coming through, so it is very frequent. As to whether you should worry about being sued, well, I would say you know clearly it’s not a position that anyone wants to be in. But at the same time I would say it’s important not to worry too much about it, because I remember the fear that I felt just evening, dental school and in the early years, about being sued, and I remember speaking with friends who said they would go home every night and think about what they’ve done that day and what they might be sued for. I just think that’s an awful way to live your professional life, you know, just because if someone is sued it doesn’t mean you’re a bad dentist. We’re all humans, we all make mistakes. I’ve heard it said that a dentist makes on average two to three errors every day and I’ve been told that on average, pilots make on average 30 mistakes a day. But you know, thankfully most of those errors don’t result in serious problems, but you know, some of them unfortunately do. But I’d say that as long as you’re doing your best with your work, you know, following recent guidelines, keeping up to date with everything, it shouldn’t be something that you’re worrying about too much. I know people do become very preoccupied with it. That’s just, it’s not. It’s not healthy. It’s one of those things where, if something goes wrong, you know the patient needs to be compensated and it’s as simple as that. It shouldn’t be something that’s taken too personally. Of course there are some serious claims that are brought, but usually the ones that proceed something has just gone wrong and say it’s something like a tooth has been taken out incorrectly. Well, the patient suffered that loss, so it’s the wrong tooth has been taken out, but it’s not their fault that they’ve lost the tooth and essentially they just need to receive the money to replace that tooth and maintain it going forward. And it’s something that you insurers don’t really would deal with. And as long as you’re doing the best as a dentist for your patient, then that will really come across. I’ve done work for the Dental Defense Union and I’ve been in conferences with dentists and the lawyers aren’t judging the dentists professionally. They’re just sort of trying to work out what has happened, what’s gone wrong, what is the dentist position and how’s the best way to put your case. So you shouldn’t sort of worry too much about coming up in front of the lawyers. They’re not going to sort of tell you off or anything, they’re just kind of going to try and talk through with you how best to manage this. And I know that some people as well end up sort of practicing what’s called defensive dentistry, where they’re just worried about being sued and don’t want to go on training courses and try out new things, and again it’s such that there’s not the best way to be living your professional life and reaching your full potential. I think it’s really important to always have it in mind that there’s always this risk, but you don’t follow the guidelines. Do your best at every patient, recording everything in your notes as best as you can, but I just think it’s important not to spend your professional life being scared of being sued.

Dr James: 

Yeah, yeah, I mean the thing is. I think the thing that gets me about dentistry sometimes is that how often in your experience maybe you might set me straight on this one but for me it’s kind of like you can do everything that you can. Everything can look really good as far as you’re concerned and maybe the patient will just get upset about something that isn’t really in it. Let’s just give a tangible example. Say you take a tooth out and you say afterwards OK, there’s a risk of infection, there’s a risk of a dry socket. Yeah, patient comes back with a dry socket. They have it in their head that it’s your fault somehow. So let’s say, for example, you’ve documented that there’s going to be an infection, there’s possibility of a dry socket, something like that. So that’s a fairly standard thing to write in a note. Ok, so as far as you’re concerned, you’ve put it in the notes. Have you necessarily fully explained all the ins and outs of every single possible ramification of what a dry socket might be? No, because it’s very difficult to do that in a however long appointment 15, 20 minutes and then you’ve written as far as you’re concerned, you put it in the notes. The patient comes back with a dry socket, like I say, and then you reassure them that it’s fine, and then they kick up a fuss and then afterwards it goes to court, whatever a lawyer looks at it, and they say well, technically you haven’t explained that this dry socket could be painful, or I don’t know that there could be swelling or how long this might last. Or there’s this say, you’ve spelled the word dry, you’ve missed, you’ve put R before D or something like that. Literally something tiny. That’s what I mean. Yeah, OK, yeah, what I mean is is that, is it commonplace that that would be an issue? That’s there’s. There’s the best example of a technicality that I can give you. It’s just a minor spell on mistake, or something like that.

Speaker 2: 

I see what you mean, yeah, so I mean a lawyer is not going to pick you up on a spelling mistake. I just I’m going to think anything bad about that, especially because you know they understand that dentists are very busy professionals. That’s not something that’s going to cause you a problem. If taking the tooth out, ideally you explain the risks. So, for example, pain, swelling, bruising, bleeding, they are all natural risks, inherent risks of an extraction, and if one of those arises, it would be really difficult to say that it’s because, well, first of all, if you’re going to prove that a dentist has, if the claim is going to have a successful dental negligence claim, they need to prove that the dentist breached their duty of care and in in that it’s that their care fell below the standard of what would be expected of a reasonably competent dentist and that that breach caused the loss of the patient suffered. So if, for example, it’s taking a tooth out and you’ve explained the risks and the patient comes back well you know, unless there’s an expert for the claim and saying, well, it’s because of what the dentist did, which would be quite difficult to prove I would say then the general view would be well, this is an inherent risk. It’s explained to the patient. They understood it. It’s difficult to prove what did the dentist do that fell below the standard of reasonable care, as long as they took all of the tooth out completely, it was fully extracted, hemostasis et cetera. All of that, and then, if they have fallen, below the standard in any of those did that cause the loss. So you know, consent is one thing. So that was my next question.

Dr James: 

So I get that it’s maybe not a negligence thing, but it could be a consent thing. There you go, and then there’s another reason why it could be a technicality.

Speaker 2: 

It’s anyway sorry to jump in, but yeah, because I think that is, and it’s been a case I don’t know if you know about it but Montgomery is quite a recent case on informed consent and it says that all medical professionals have to explain all the risks of procedures in order to gain fully informed consent. So really, you know, ideally you should explain the risks to your patient and then document it, something to say that the patient understands, patients wanting to go ahead with the treatment. If you’ve got all of that, you sort of you know, you’re covered, really, as long as you know that the patients understood the risks. If you haven’t documented a risk for example that you know that you have explained it or that you always do, you know you can put that across and say that that’s what I always do. But it’s just, if it’s not in your notes, it’s not going to be a firm and argument. So if it’s written down, it’s going to always be better for you. Otherwise you can say, well, this is what I always do, I would have done that. But then there will be some cases where people will say, well, if I’ve been informed of this particular risk, I wouldn’t have had the procedure, and those cases can succeed. But if it’s someone with, say, a really infected wisdom tooth, lots of pain, swelling, you know, if you leave it, what are the risks? Well, the potential, you know, such asemia and so on and extensive swelling, ongoing pain. What would you be looking at as well? Okay, it’s not in your notes that there’s a risk of dry socket. Had the risk of dry socket been explained to the patient, would they still have gone ahead with the extraction? On balance, probably yes, given that dry sockets are relatively minor problem compared to what could happen if you left an infected tooth in there. So you know, on balance, even if the patient says, well, I wouldn’t have had it extracted if I’d known the risk of dry socket, you know, just will look at. Is that reasonable? Well, you know balance, you probably would still have had it anyway. So the failure of the dentist to inform the patient of the dry socket didn’t cause it, if you see what I mean. So you kind of then may have the point where it’s. You can succeed on the causation argument that that wasn’t what caused the loss because they would. Even if you had explained it to them, they would have gone ahead with the treatment anyway. So it’s not sort of the fact that just because something isn’t in your notes or you haven’t written it down and you sort of worrying about that, it doesn’t mean necessarily you’re automatically going to be seen, it’s all going to go wrong. There’s quite a few stages to go through for that to happen.

Dr James: 

Yeah, no, that’s. That’s interesting in itself, because I would have thought, or presumed afterwards that, even though they definitely would have had that to thought there was a massive abscess, all the rest, that if they got a dry socket afterwards and they, for whatever reason, would dissatisfied with that, that they probably still, at my understand, would have been that they probably still could have caught you out there. I don’t know, I don’t know, but that’s Reassuring because it means that there is a little bit of balance in there or there’s something that goes in our favor, if that makes sense.

Speaker 2: 

Yeah, I mean, I think it’s always important to you know, to get informed, content for everything, to document everything as much as you can. You know, but but don’t worry unnecessarily at the same time. Yeah, you could have a patient complaining. They might not be very happy about it and you might be wondering. You know that might be a different matter. You might think, well, we’ll talk about it and explain it and try and resolve it. But it doesn’t necessarily mean that they’re going to have successful dental negligence claim against you, for example.

Dr James: 

Cool, interesting stuff, and I wanted to know as well how much in your experience is good record keeping actually make a difference, because we’ve heard stories where the indemnities they quite often Find it cheaper to pay out, then go through the litigation process or to actually take this to court. So I know that you’re always going to say that it’s worthwhile to keep good records, but how useful are they and how frequent is what I’ve just described? Real quick, guys. I put together a special report for dentists entitled the seven costing, potentially disastrous mistakes the dentist make whenever it comes to their finances. Most of the time, dentists are going through these issues and they don’t even necessarily realize that they’re happening until they have their eyes opened, and that is the purpose of this report. You can go ahead and receive your free report by heading on over to wwwdenisoninvestcom forward slash podcast report or alternatively, you can download it using the link in the description. This report details the seven most common issues. However, most importantly, it also shows you how to fix them. Really, looking forward to hearing your thoughts.

Speaker 2: 

Yeah, I think so. I think there are two points there Whether record keeping makes a difference and whether, as you say, it indemnified fires just find it cheaper to pay out. So on the first point, yes, good record keeping does make a difference. That’s the first thing and the main thing that the lawyers representing you would be looking at if a claim was to be brought against you. It’s documentary evidence, contemporaneous notes of what happened at the time. And not only does good record keeping help you to defend a claim, but it also paints picture. So detailed record keeping suggests a careful, conscientious dentist and that will come across a trial and that will work in your favor. If you’ve got brief, haphazard notes suggesting the collision, that isn’t all that bothered, it could go against you and it may not be the case that it’s not bothered. But you’re just really busy and you know just doing the best that you can. But just be aware that that is a documentary evidence that’s going to go before the lawyers and before the judge.

Dr James: 

So, sorry to jump in it’s maybe slightly an ethereal thing, then, in that it’s just you being able to prove that you’re conscientious and that will swing the balance in your favor rather than it being black and white. You should have this, you shouldn’t have this. Have I grasped that correctly?

Speaker 2: 

So I think two things really that when you’re looking at the particular incident in question, the lawyers and judge will be looking at your dental records around that particular matter. They’re trying to decide and determine what happened and what went wrong, if something did go wrong, what you did right and what you did wrong, but also it will paint a general picture, and just, of a conscientious dentist. Poor record keeping in itself as well can be considered a breach of duty. So you know, if the lawyers look at it and think, well, these records fall below the standard of a reason with competent dentist, that could be an additional breach of duty of your care. So it’s something else that the claimants lawyers will be looking at when they’re deciding how to see you. Consent is a big thing, such a big thing as I’ve talked about, and you can be sued for failing to obtain informed consent. So again, when getting gaining consent, it’s really important to make a record of all the discussions around or team consent that you’ve done it. So explain the diagnosis, the treatment options, the risk of those options, costs and what was said, what treatment the patient decided on and why. And it’s just good practice to keep good records because when you’re treating that patient. You can look through and see what was done and probably instantly remember. If it’s more detailed, it’s going to bring back a better memory for you. If another dentist treats your patient, then they’re going to know what’s happened as well and be able to treat that patient to the best of their ability. Yeah, I mean about the point about indemnify, signing it cheaper to just pay out In my experience. Well, the indemnify, if they receive a claim from a patient, then they will instruct lawyers, socialists as embarrassed is to look at the claim and also the dentist records. They will probably instruct an expert to look at the records as well and consider how well placed they are to defend the claim. They will. The barrister typically will draft a robust defence defending, defending allegations and admitting any allegations that the dentist wants to admit. The dentist is a part of that as well. The dentist is brought into the conference with a member of the defence organisations list of barrister. The dentist will be invited to say what they admit, what they deny, what they put the claimant to proof on and why. And obviously that’s going to depend largely on what you have in your records, because if you’re saying something happened but it’s not recorded. You can still put it in the defence if you’ve certain that happened. But it’s just, it’s going to be your oral evidence rather than the documentary evidence supporting your case. And then, once a defence is drafted, then that is with the assistance of the dentist, because the dentist signs it at the end of it to say that they agree with that. Then both parties will try to reach settlement, and that’s in order to avoid having to pay the very hefty litigation fees. But it’s not the case that they just will pay, whatever the claimant wants. So what is paid will depend on, firstly, whether the claimant has a case at all because it might be that they don’t and everything’s denied, or at least the indemnifies consider that to be the case. If they do think that the claimant has a case, then how strong the case that is will depend upon how strong the dentist’s defence is, and that’s really based on what the dentist says and what’s in their records. And then the parties will try to reach some sort of agreement that everyone’s happy with. But so a lot goes on before it even gets to litigation. So all of that goes on behind the scenes and then the parties try to settle it and only in certain circumstances will it go to court, if both parties are just so far apart. But it cost an awful lot to run these trials at court. Put a, get experts in. It runs for several days and that’s why, if possible, the parties will try to settle it. But it’s not just a sort of they just pay out. It’s not like that. A lot of thought goes into it.

Dr James: 

I say interesting. Maybe we can make another podcast out of this. But consent specifically in your opinion, is it possible to gain informed consent? Because I’ve heard people who are lawyers said that it’s very difficult to actually do that close to impossible, because by the time you’ve given somebody all the information that they need to make a decision you have to bear in mind there’s extra things that you might tack on top, based on their unique medical history, and there’s a lot of information to get across to that specific individual. What’s your opinion on that?

Speaker 2: 

It’s going to be very difficult because you’re going to have to think about so much and talk about a lot, and then it may well be that you talk through the running the history of treatment options in full, but then actually documenting it all as well is going to take time.

Dr James: 

Yeah, exactly yeah, and I fully appreciate that.

Speaker 2: 

So you just have to do the best that you can really.

Dr James: 

I think that’s the best, that’s the most actionable, practicable thing that you can say, because it’s so impossible to get. All of it’s what you say. It’s what you say, it’s what you have to, it’s all. You have to tailor that to make it unique to that person, which you should be doing every time. All right, there might be things that are totally unforeseen. You know weird medical conditions. You’ve never heard of one in a million things like that. And then it’s also structuring it so that the information is tangible to that patient or they’re able to give it back to you. Going back to my uni days informed consent, it’s a decision. There’s three parts to it. They have to be able to understand, retain, weigh up and communicate information and give it back to you. There’s four parts actually. Sorry, that’s it right? Yeah, yeah, I think so. Yeah, that’s my from memory, but you’ll know better than me.

Speaker 2: 

Yeah, yes, that’s right, and just kind of making sure that you explain all the risks as well, explaining the treatment options, going through it all, making sure that they fully understand it, as you say, that they can communicate it back to you and when you talk about what treatment option they’ve decided upon, you know, talking to them about it, maybe asking them a couple of questions why we decided on that, just to make sure that they fully understood it and, if possible, documenting it as much as you can.

Dr James: 

Awesome. What are the most common things that you see dentists get caught eyeed on?

Speaker 2: 

Obviously every case is unique, but I would say that a really big thing, important thing, is changing notes so you know you’ve got a contemporaneous record of what happened. If the dentist then goes in and changes that you know following the receipt of a claim, then that can be tracked through the computer. Or if you look at paper records, sometimes they have codes on the bottom of dates and you can tell that something’s out of sequence.

Dr James: 

Surely everyone knows that about computers, that you can see the date change in front of you. I mean, when I’ve had to go, sometimes you write notes and then you come back the next. You go home and you think, oh, I should have put that in, yeah. And then you come back and you write the next day, which is fine, by the way. You can do that if something else pops into your head, but after a claim comes in, that’s a completely different kettle of fish. You know what I mean. But I’m surprised to hear that people still do that, or that’s still a thing.

Speaker 2: 

Yeah, it can happen and I think people just sometimes panic. But clearly that’s a really big no note because you know it’s accepted, people make mistakes and so on. But if dishonesty comes into it, that’s kind of when you could end up in front of the GDC, because it’s just questionable as to whether or not you can be trusted.

Dr James: 

I see.

Speaker 2: 

With patience. So for that, another thing is using templates, for example quick notes. So if you have a dentist where at every appointment if something’s gone wrong it could be, for example, a periodontal case and it’s not been properly diagnosed or not been properly treated and at every appointment you just have this quick note saying you know, oral hygiene advice, given smoking, cessation advice, given the scale of polish, you know it’s repeated every time. It’s going to be really difficult to rely upon that. And so well, I did give proper advice and I did give proper treatment. Because it would appear to a lawyer and a judge that perhaps you just copy and pasting without any specifics. How do we know that you have actually done this, not just copy and pasted a note? So I can understand why templates, quick notes, are used, because it helps to save time. But it’s important to try and then tailor it. So once you have that quick note, edit it slightly. That’s really what actually happened in that, in that appointment. Yep, thank you for that. No, it’s okay, and just to make it really clear that you haven’t just copied and pasted, not thought about it. Another thing is just notes that aren’t really detailed enough. I know it’s not so it’s not so frequent now, but going back you see sort of just exam scale and polish. That’s. That’s what you would see. They’ve gradually become more detailed but just not quite enough. As to everything that happened, for example, you know things like all the carers has removed dentiners, sound line was placed, all of those sort of things. If, for example, the patient comes back and has problems with filling, that’s something that we’ll be looking at. Not covering consent properly, which we talked about, and really periodontal disease is quite a big one. So you get a lot of periodontal cases and diagnosed periodontal disease that hasn’t been properly treated. So in that, really fully recording BPEs, recording the diagnosis, doing further charting if necessary, recording treatment options, treatment that was done, whether oral hygiene advice was given and kind of specifically what that was, so whether it’s using interdental brushes or floss or mouthwash if smoking cessation advice was given, those sorts of things which really not having enough detail on those points Kind of then portrays if it’s over a period of time, portrays a picture of dentists that hasn’t really properly managed the situation and has therefore contributed to the patient’s progression of disease.

Dr James: 

Yeah, fair enough. Fair enough, and I know that this might be a hard one for you to answer. But going back to when you were talking about detail, again, this is something that I’ve never really had any formal explanation of. But let’s use a filling, for example. Now, the reason why this might be hard to answer is it’s going to be different for every procedure, of course. But let’s use a filling, for example. Now my quick note. For a filling. It says clean decay, all decay at margins, clean. And then it says, you know, soft. Or it says firm dentine left in the middle. You know as you should do, you know, at least that’s how I do it. Anyway, I don’t remove all the decay, it just needs to be cleaned at the margins. And then I’ll say something like etched margins with phosphoric acid, etched enamel with phosphoric acid. And then I’ll say generation seven bond used, massaged into the center of the tooth, built up with flouable, whatever composite on top. Okay, now, that’s just. That’s my quick note. All right, now, that is what I’ve put in. I went in. Maybe I’ve put a little bit more detail in there than a lot would. I don’t know. Is that too much detail? Is there a right level of detail. Obviously, you could spend all day putting every single thing that you did in there. What’s the right amount? Again, I feel. I know I know that might be a little difficult to answer, but maybe if you could just give us some general pointers.

Speaker 2: 

Yes, that sounds like a good level of detail, I would say Very detailed. I think again, if you’re using that typically for each patient or which feeling that you do, just sort of editing it slightly, as in, you might have some cases where you need to use the slow speed handpiece, for example, to remove because you think it’s getting close to the pulp, so just kind of tailoring it to that particular tooth or that particular treatment, any particular difficulties that arose, just tailoring it again to that particular treatment, so that it’s clear that you have done everything that’s in your nose and you have really thought about it. But as a general overview I think that sounds like the right amount of detail to demonstrate that you’ve done everything that you should and also that you’re a conscientious dentist and that you do keep good records and that you do care about what you’re doing.

Dr James: 

That was it as well, because that’s what we sort of briefly chatted about this earlier, before we started shooting, didn’t we? And a big thing is just being able to display that you’re conscientious, because a lot of these decisions, when they come to the court, it’s the decision of a judge. Ultimately and maybe it’s not always black and white There’ll be a little bit of a gray area there as to which way the decision could go, and that would make it swing things in your favour, certainly, if I’ve grasped it correctly.

Speaker 2: 

Yes, that’s right, and I think that is the thing in law that it is always gray, it’s not black and white. That’s why these cases go to trial, because one party is saying one thing, one party is saying another and the judge has to make a decision. The judge usually sees dentists as fellow professionals, and having good, detailed notes does show that you’re conscientious, that you care about what you do, and that’s always going to come across well and paint a good picture of you, and that’s a good starting point.

Dr James: 

Awesome. How much should we be updating medical history, Because people tell me different things all the time. Should it be every appointment? Should it be at the check-up before we do treatment which is prescribed from that appointment? How often?

Speaker 2: 

I would suggest that the medical history is updated at every appointment if possible. That’s because if the patient has a medical emergency, for example, and the medical history isn’t updated, then something could go seriously wrong. For example, if they’re unconscious, you can’t then ask them what might be wrong. They’re going to be struggling. Ideally you want to know if there’s anything that has changed before you do any treatment or really get them into the surgery at all, if possible. So ideally they hopefully sign something in reception to check the medical history, come in and then also you check again, just say has there been any change to medical history, anything I should know about? And obviously also you need it really, just because when you’re considering the whole patient, when you’re deciding a treatment, you need to know everything that’s there. So again, you’re not going to be that face with some musty surprise. Fair enough, if the patient started taking warfarin or something and you take a tooth out, well, this is it. I mean, it’s possible isn’t it?

Dr James: 

It’s unlikely, but it’s possible, and then you wouldn’t really have a leg to stand on, would you? But I’ve heard others say that, oh, it’s not really necessary, you know, just do it when you’ve got an exam and then you’ve got subsequent treatment from it. Just do it at the exam and then they’re good for however long. But it never really quite added up with me, you know, because it’s very possible. And, louisa, I wanted to ask as well, how does that medical history update look? Is it a simple ascent of the patient, any changes to your medical history at the start and then just clicking reviewed on the computer? Or should we have them? I know this might be a bit OTT, but really should we be having them review it every time themselves and maybe fill in the new form, or just click, tick, nothing’s changed? I don’t know how does that look. How does that look, that update for the medical history?

Speaker 2: 

Ideally, the medical history should be given to them to read through. That’s assuming that they, that they can read and that they’re comfortable with all of that and that they they sign it, whether that’s a paper form and you have a date and their signature through each appointment and they can either do that reception or in the surgery and then, or, if it’s online, you might have a tablet that they can look at and they can then make any changes that they need to. And then when they come into the surgery, you should really check it with them, say any changes, anything you know about. You might think if they’ve got a particular condition, you might see how’s everything going with this. For example, it has everything going with the diabetes or your orphan treatment, just to kind of to the case of something we haven’t thought of. And then you just sign it yourself as well, I think ideally so that it shows that they’ve looked at it, signed it, You’ve talked to them around it, you signed it and then hopefully you should have everything covered.

Dr James: 

Brilliant, brilliant. Local anaesthetic and the batch number. Can we, can we put this to bed? Do we still need to put the batch number in for local anaesthetic? Because that takes you know it’s an extra 30 seconds and that can. That can save a lot of time. You know, if you run and lay at something like that.

Speaker 2: 

I know it’s like everything in record keeping. It all takes time and it’s difficult when you’re pushed, but I think ideally, if you can, it’s a good thing to do. Again, it shows attention to detail If there’s a problem with a particular batch. You don’t want to be an dentist, you haven’t recorded what was given to whom, etc. And it just also maybe makes you just double check that, the date, that it’s still in date and so on. But when it comes to dental negligence claims, I would say that it’s unlikely that that’s going to play a big part other than showing conscientiousness. Because they’ve talked about sort of breach and causation and really it might be something that a lawyer might think we haven’t recorded a batch number but really has that caused any loss in those situations? It won’t have done. But again, just attention to detail.

Dr James: 

You ever had a case of that nature in your experience.

Speaker 2: 

I’ve had. I’ve seen cases where dentists haven’t recorded it and I think it’s just something that you sort of mentally think, okay, they haven’t done that, is there attention to detail? As good as everywhere else, or you know it just again general inflection, but no case sort of brought on that particular point and that point’s never actually, in any of the cases I’ve been involved with, been a really relevant point.

Dr James: 

Just curious. Wonderful, louisa, this is some amazing information and I’ve definitely come out the other side of this with a new understanding of how I should be looking at my notes and maybe I was more coming from the point I graduated in 2016 and, as the years have went on, the attention to detail in the notes has increased. They’re longer, etc, etc. And I really just didn’t have an idea of how much the info there should be in there and what I should be doing. And I think the main thing, if we could just take one thing away from this podcast, it’s to just try and display that you’re conscientious, display as much information, write as much information as possible and then after that you know you kind of just have to. There’s almost a little bit of a fingers cross situation after that, to a degree only because it’s so difficult to completely prescribe completely informed consent to every single person. I think that’s maybe the take home message. Is that correct?

Speaker 2: 

Yeah, I would say so. So, as you said you know, do the best you can. It will show that you’re a conscientious dentist. Make as many notes as you can, anything you think that might cause any problems or where you really want to get the point across in your notes that something has been done, obviously make a point of doing that, but at the same time you can only do. You know what you can do really. So do the best you can and try not to worry too much about it individually, because if you’re following keeping up to date with the GDC guidelines, keeping up to date with all of the regulations and advice, doing CPD so you know what procedures you should and shouldn’t be doing, and doing the best way you can, then really that’s all that you can do.

Dr James: 

Fair enough, louisa, let’s round off on a high. What are your powerful, punchy, short, impactful top tips for staying out of trouble for days? What do you think?

Speaker 2: 

about that, the dentist, I think so. First of all, be nice to your patients.

Dr James: 

True, so true, it makes a huge difference. It really does.

Speaker 2: 

Yeah, because if they’ve got a problem and you’ve got some good rapport with them, if they have concerns, they’re more likely then to come to you and talk about it. And then if they do come to you with a problem, listen and you know, don’t take it personally really listen and see what they want and try and help them and try and resolve it there. And then, if you can because you don’t want it to escalate to litigation, which is an ongoing length process and going to be a little stressful so say keep up to date with all the guidance regulations and make notes as detailed as you can, consent as best you can, making sure you’ve outlined treatment options and that you’ve communicated that to the patient, as the patient understands. And the other point which we’ve already covered and it is unusual, but when people are planning it it does happen just not changing your notes or trying to make it look like you’ve changed them that day. By all means add something, but just date it with the future date. You know, if you’ve thought about something but date it and say I’ve considered this and just want to add this point.

Dr James: 

Some really useful stuff there. Louisa, thank you so much, and you are, of course, a lawyer who helps. How about you, dennis? Would you just like to explain a little bit more about how you do that for anybody who’s listening who may be interested in getting in touch?

Speaker 2: 

Yeah Well, I love to help, dennis. That’s kind of what I feel most passionate about. Having walked in your shoes myself, I understand it’s a really stressful profession and most people enter dentistry not wanting not really thinking about the legal side of it, but wanting to help people. And legal problems do arise, be that dental negligence, commercial, contractual disputes and so on. So, yeah, so I help dentists clinical negligence, dental negligence claims. I’ve been instructed by the Dental Defense Union to represent dentists and defend them in claims. Also, I do commercial work. So representing and advising dentists who have contractual disputes, for example, regarding associate contracts, pay. Also representing and advising dentists who might have a contractual dispute involving a member of the team, like an Israel hygienist, and disputes which arise following the buy-in, selling of a practice and partnership disputes and so on. I am led to dentists as part of their CPG Unrelevant Legal Matters and I’m also qualified as a mediator. So if the dispute arises, then instead of going to court, I can come in and act as a neutral third party and help the parties to reach a resolution that works for them without them having to pay extortionate legal fees. And the beauty of mediation is that the parties can agree to whatever they want as an outcome. It might be something as straightforward as an apology, something like that, and that can just help solve matters there before they progress any further.

Dr James: 

Wonderful. Thank you so much for that, Louisa. Louisa, we’re going to wrap up now. I thank you so much for coming on the show.

Speaker 2: 

Thank you for inviting me. It’s been an absolute pleasure.

Dr James: 

I’ve learned a lot. I really have learned a lot, and I hope that that was very useful for everybody who’s listening. As well as that, we should mention that Louisa is on the Facebook group. Of course, louisa Sherlock. You’ll be able to search her name in the members category should you want to get in touch with her, and for anybody who’s listening but they’re not in the Facebook group, you can find us on Facebook. Dentist who Invest. Community Group for Dentist who Enjoy Trading, finance, money, all these things with a dental spin, and it would be an absolute pleasure to have you on there, should you think that that would be of interest. As I say, we’re going to wrap up now. Louisa, thank you so much for your time.

Speaker 2: 

Thank you so much for inviting me today. I really enjoyed chatting with you.

Dr James: 

Thank you, that’s very kind. Louisa will speak very soon, I’m sure In a bit. Bye-bye. Thank you very much. If you enjoyed this podcast, please hit, follow or subscribe so you can stay up to date with information on new podcasts which are released weekly. Please also feel free to leave a positive review so others can learn about this podcast and benefit from it. I would also encourage any fans of the podcast to sign up to the free Facebook community from which the podcast originated. Please search Dentist who Invest on Facebook and hit join to become part of a community of thousands of other dentists interested in improving their finances, wellbeing and investing knowledge. Looking forward to seeing you on there.