Dr Martin Foster, Dentolegal Consultant at Dental Protection, looks at the importance of enforcing infection control measures during the COVID-19 pandemic
The COVID-19 pandemic has created an often overwhelming need for measures to be put in place to reduce the risk of virus transmission. However, at Dental Protection we are aware of difficulties presented in practice by patients who refuse to comply with these measures. Examples include patients refusing to wear masks when they attend the practice, objecting to using hand sanitisers, having their temperature taken and even being coy about disclosing symptoms or their COVID-19 status when being triaged.
There may be many reasons for such behaviours and it highlights the tension between what the patient perceives as a matter of choice and the need to protect others. Not uncommonly, team members can find themselves caught in the crossfire as they strive to do ‘the right thing’. It may be helpful to review some of the techniques to manage these challenging situations in a professional and polite manner so as not to offend the patient.
The most common reason for non-compliance is that the individual has focused more on self-interest rather than the ‘greater good’ and has not fully understood the duty of care to protect the public at large. This may seem obvious but it is surprising how often it needs to be spelled out. There are a number of ways to reinforce this principle and one way is to communicate it in a series of simpler messages, each of which is logical as a standalone statement.
Creating a safe environment
• The practice environment needs to be kept as safe as possible to protect other patients as well as members of the dental team. Failing to take all reasonable steps to achieve this would reckless and professionally irresponsible.
• As with all healthcare professions, the dental team’s primary duty is to do no harm. Making an exception to infection control protocols and thereby increasing the risk of introducing a harmful infection into the practice is unacceptable.
• To keep everyone safe, it is respectfully requested that anyone wishing to access care complies with the measures in place.
What are your professional obligations?
• All healthcare professionals are subject to a range of ethical and legal obligations. These include protecting the health and safety of patients and colleagues, adhering to the highest standards of professional practice, and of course ensuring compliance with current guidance and requirements around infection control.
Practices do not make the rules – but we need to follow them
• The patient may have their own views on the measures in place and may adopt a particular position with regards to compliance. In contrast, the practice and the dental team have a wider ethical responsibility and irrespective of their personal views have a professional obligation to comply with expected standards.
• For the dental team, the Dental Council and other organisations set the standards that must be followed and it is a requirement for practices to adopt them as part of the standard operating procedure. The individual clinician does not have the authority to vary or modify these standards.
• The dental team has an ethical duty to adhere to the rules and guidelines. It is not appropriate for dental professionals to take risks with the health of those for whom they have a responsibility to protect.
Accepting conditions and respect for choice
• There must be mutual trust and respect between patient and clinician for care to be provided satisfactorily. Patients do have the right to choose between treatment options, but the delivery of care is set within boundaries, outside which treatment cannot be provided. Patients have long been expected to comply with certain conditions – providing a medical history and not smoking in the surgery are just two examples – so the idea of complying with certain conditions is not new.
• If an individual does not wish to accept the conditions under which they can been seen, which are there for reasons of safety, they are free to exercise their choice not to attend.
You cannot please everyone all of the time. There may still be those who despite careful explanation will continue to voice their objections. Being challenged over taking care with infection control measures during a pandemic is not the worst type of complaint to receive, and the team at Dental Protection are happy to assist members in managing these situations.