MJDF Law Ethics and Professionalism 2 — Questions and Answers
Question 1: What is the duty of candour in dental practice, and what does it require when a patient safety incident occurs?
- Dental professionals have no obligation to inform patients about errors
- The professional duty of candour (GDC) and statutory duty of candour (CQC Regulation 20) require dental professionals to be open and honest with patients when something goes wrong with their treatment, to apologise (apology is not an admission of liability under the Compensation Act 2006), explain what happened, offer appropriate remedy, and support the patient (Correct answer)
- Candour only applies to hospital-based dental treatment
- The duty of candour prevents dental professionals from apologising as it may be used against them in court
Correct answer: The professional duty of candour (GDC) and statutory duty of candour (CQC Regulation 20) require dental professionals to be open and honest with patients when something goes wrong with their treatment, to apologise (apology is not an admission of liability under the Compensation Act 2006), explain what happened, offer appropriate remedy, and support the patient
The duty of candour has two components: the professional duty (GDC Standards — Principle 1.3.3: be open and honest with patients if something goes wrong) and the statutory duty (CQC Regulation 20: organisations must notify patients of 'notifiable safety incidents' where moderate or severe harm occurred). Requirements: tell the patient (or their representative) what happened as soon as possible, offer an apology (the Compensation Act 2006 section 2 confirms that an apology is not an admission of liability), explain the consequences, offer remedial treatment, and document the discussion. Failure to comply with the duty of candour can constitute a fitness to practise issue (GDC) or a regulatory breach (CQC).
Question 2: What are the legal requirements for dental record keeping in the UK?
- Records only need to contain the patient's name and treatment provided
- Records must be contemporaneous, accurate, legible, and comprehensive, including patient identification, medical history, clinical findings, diagnosis, treatment plan (with consent discussion), treatment provided, materials used, prescriptions, radiographs taken with justification, and any complications; they must be retained for a minimum of 10 years (adults) or until the patient's 25th birthday (whichever is longer for children) (Correct answer)
- Records are optional if the patient is a regular attendee
- Digital records do not need to meet any specific standard
Correct answer: Records must be contemporaneous, accurate, legible, and comprehensive, including patient identification, medical history, clinical findings, diagnosis, treatment plan (with consent discussion), treatment provided, materials used, prescriptions, radiographs taken with justification, and any complications; they must be retained for a minimum of 10 years (adults) or until the patient's 25th birthday (whichever is longer for children)
UK dental records must meet GDC, CQC, and medicolegal standards. Essential content: patient demographics, comprehensive medical history (updated at each visit), presenting complaint, clinical examination findings, diagnosis, treatment options discussed (including risks, benefits, alternatives), consent record, treatment provided (including materials, batch numbers for implants), local anaesthetic type/dose/batch, radiographs (with IRMER justification, report, and quality rating), referrals, and any complications/incidents. Records must be contemporaneous (made at the time of treatment), factual, legible, and in permanent form. Retention: NHS — 10 years from last entry or until age 25 (whichever is later); adults — 10 years; children — until age 25. In negligence claims, the patient must prove breach of duty, so adequate records are the clinician's best defence.
Question 3: What is the difference between negligence and an adverse outcome in dental treatment, and what must a patient prove to succeed in a negligence claim?
- Every adverse outcome constitutes negligence
- Negligence requires proof that the practitioner owed a duty of care (exists for all patients), breached the standard of care (the 'Bolam test' — fell below the standard of a reasonably competent practitioner, modified by the 'Bolitho test'), and this breach caused the patient's harm (causation); an adverse outcome alone does not constitute negligence if the treatment met the required standard (Correct answer)
- Negligence can only be proven if the dentist intended to cause harm
- Patients cannot bring negligence claims against dental professionals
Correct answer: Negligence requires proof that the practitioner owed a duty of care (exists for all patients), breached the standard of care (the 'Bolam test' — fell below the standard of a reasonably competent practitioner, modified by the 'Bolitho test'), and this breach caused the patient's harm (causation); an adverse outcome alone does not constitute negligence if the treatment met the required standard
Dental negligence in UK law requires the patient (claimant) to prove three elements on the balance of probabilities: (1) Duty of care — automatically established in a dentist-patient relationship; (2) Breach of duty — the treatment fell below the standard expected of a reasonably competent practitioner in that field (Bolam v Friern Hospital 1957), AND the body of opinion supporting the practice must be reasonable and logically defensible (Bolitho v City and Hackney 1998); (3) Causation — the breach directly caused the harm suffered ('but for' test — but for the negligent act, the damage would not have occurred). A poor outcome despite competent treatment is not negligence — medicine involves inherent risks even with optimal care.
Question 4: What is the dental professional's responsibility regarding safeguarding children and vulnerable adults?
- Safeguarding is not the responsibility of dental professionals
- All dental professionals have a legal and professional duty to recognise signs of abuse or neglect (physical, emotional, sexual, neglect, domestic violence), report concerns to the local safeguarding team, follow the practice's safeguarding policy, maintain safeguarding training, and document any concerns; failure to act on safeguarding concerns may constitute a fitness to practise issue (Correct answer)
- Only dentists (not dental nurses or hygienists) have safeguarding responsibilities
- Safeguarding concerns should only be reported if there is definitive proof of abuse
Correct answer: All dental professionals have a legal and professional duty to recognise signs of abuse or neglect (physical, emotional, sexual, neglect, domestic violence), report concerns to the local safeguarding team, follow the practice's safeguarding policy, maintain safeguarding training, and document any concerns; failure to act on safeguarding concerns may constitute a fitness to practise issue
All GDC registrants have a duty to safeguard children and vulnerable adults (GDC Standards Principle 8, Children Act 1989/2004, Care Act 2014). Dental professionals are well-placed to identify abuse: orofacial injuries (most common site of non-accidental injury in children), neglected dental disease, inconsistent explanations for injuries, behavioural changes, and signs of neglect. The threshold for reporting is concern/suspicion, NOT proof — it is not the dental professional's role to investigate, but to report to the local authority children's/adult services or the NSPCC. Practices must have a safeguarding lead, written policy, and all staff must complete appropriate training. Failure to raise concerns when abuse is suspected is a serious professional conduct issue.
Question 5: What are the CQC (Care Quality Commission) fundamental standards that dental practices in England must meet?
- CQC only inspects hospitals, not dental practices
- CQC regulates all dental practices providing NHS or private treatment in England against fundamental standards including: safe care and treatment (Regulation 12), good governance (Regulation 17), safeguarding (Regulation 13), staffing (Regulation 18), complaints (Regulation 16), consent (Regulation 11), and duty of candour (Regulation 20); practices are rated Outstanding, Good, Requires Improvement, or Inadequate (Correct answer)
- CQC registration is voluntary for dental practices
- CQC only checks financial records of dental practices
Correct answer: CQC regulates all dental practices providing NHS or private treatment in England against fundamental standards including: safe care and treatment (Regulation 12), good governance (Regulation 17), safeguarding (Regulation 13), staffing (Regulation 18), complaints (Regulation 16), consent (Regulation 11), and duty of candour (Regulation 20); practices are rated Outstanding, Good, Requires Improvement, or Inadequate
The CQC is the independent regulator of health and social care in England. All dental practices (NHS and private) must be registered with CQC and meet fundamental standards. Key regulations include: Regulation 12 (safe care and treatment — including infection control, medicines management, equipment maintenance), Regulation 17 (good governance — risk assessment, audit, policies), Regulation 13 (safeguarding), Regulation 18 (staffing — sufficient, qualified, trained), Regulation 16 (complaints), Regulation 11 (consent), Regulation 20 (duty of candour), and Regulation 15 (premises and equipment). Inspections assess five key questions: Is the service safe, effective, caring, responsive, and well-led? Rating outcomes can result in conditions, warning notices, or ultimately closure.
Question 6: What ethical framework should a dental professional use when faced with a conflict between patient autonomy and beneficence?
- Always override the patient's wishes and do what the dentist thinks is best
- Apply the four principles of biomedical ethics (Beauchamp and Childress): autonomy (respect the patient's right to make informed decisions), beneficence (act in the patient's best interest), non-maleficence (do no harm), and justice (fair distribution of resources); in most cases, a competent adult's autonomous decision should be respected even if it conflicts with what the clinician considers clinically optimal (Correct answer)
- Patient autonomy is always overridden by clinical judgement
- There is no ethical framework applicable to dental practice
Correct answer: Apply the four principles of biomedical ethics (Beauchamp and Childress): autonomy (respect the patient's right to make informed decisions), beneficence (act in the patient's best interest), non-maleficence (do no harm), and justice (fair distribution of resources); in most cases, a competent adult's autonomous decision should be respected even if it conflicts with what the clinician considers clinically optimal
The four principles approach (Beauchamp and Childress, 'Principles of Biomedical Ethics') provides the ethical framework: Autonomy — respect the patient's right to make informed decisions about their own care, even if the clinician disagrees; Beneficence — act to benefit the patient; Non-maleficence — avoid causing harm; Justice — treat patients fairly and allocate resources equitably. When principles conflict (e.g., a competent patient refuses recommended treatment), autonomy generally takes precedence in UK law and ethics — a competent adult has the right to refuse treatment for any reason, even if refusal may lead to harm. The clinician's role is to ensure the decision is fully informed, document the discussion, and offer ongoing care.
MJDF Law Ethics and Professionalism 2
What is the duty of candour in dental practice, and what does it require when a patient safety incident occurs?