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April 26-May 2, 201014 United Kingdom EditionPractice Management worse?... is it hot things?... or cold things?... or biting on the tooth?’... and so on. They can be use- ful when dealing with patients who seem not to understand the meaning of open questions and can thereby speed up the infor- mation gathering process. Leading questions These questions tend to be worded in such a way as either to suggest the answer or to invite a specific reply. For example ‘You have been wearing your appliance, haven’t you?’ They can be useful when trying to establish confidence and communication with a nervous, quiet, or uncommunicative pa- tient but are of limited value when seeking specific accurate informa- tion, or a more detailed reply. Medical history One of the first principles one learns at dental school is that of the importance of taking a detailed medical history before treating any patient. Most dental schools have their own design of medical history questionnaire, and this shapes the format, style and extent of any further questioning of the patient on particular points aris- ing from the medical history. Many practices, in similar fashion, take commendable care in designing and using their own medical history questionnaires which patients are asked to com- plete when attending the practice for the first time. In most cases the design provides for the patient to answer ‘yes’ or ‘no’, to a set of specific predetermined questions, and then to sign and date the com- pleted questionnaire. The dental surgeon then ensures that the patient has properly understood all of the questions (for example, where patients leave one or more answers blank), and where ‘yes’ answers have been given, further questioning of the patient will allow the details of any response to be clarified and expanded upon. Sometimes this highlights areas where further information needs to be gathered – perhaps by contacting the patient’s medical practitioner, perhaps by asking the patient to bring any medica- tion they are taking along to the next visit, so that the precise drugs and dosages can be identi- fied with certainty. In several recent cases, the patient’s medical history has been at the heart of negligence claims brought against dentists and other dental team members. It is crucially important, for ex- ample, to investigate the nature of heart murmurs, or other func- tional heart disease, in order to decide whether prophylactic an- tibiotics are indicated to prevent the risk of infective endocarditis. Infective endocarditis is a seri- ous and life-threatening disease, and most patients are left with permanent damage which has the potential to shorten their life and/or restrict its quality. Dam- ages in such cases are therefore very high indeed, often including a lifetime’s loss of earnings. Other recent cases have in- volved, for example, a failure to take into account certain aller- gies to drugs (especially peni- cillin and other antibiotics), or to recognise the significance of long-term aspirin medication predisposing to postoperative bleedings, or to recognise the po- tential for drug interactions. Cases such as these often re- veal the fact that although a prac- titioner might have taken a com- prehensive medical history when the patient first attended as a new patient, this process has either not been repeated, or has been much more superficial, when the patient has returned for suc- cessive courses of treatment. In the majority of cases, no further written medical history question- naire is ever undertaken, and indeed there is rarely any note on the record card to confirm what (if any) further question- ing has taken place to update the patient’s medical history. This can be a considerable embar- rassment when the patient has attended the same practice over a large number of years, and the practitioner is apparently still re- lying upon the patient’s original medical history details. It is self-evident that a pa- tient’s medical status is not static, and indeed, a patient’s medica- tion prescribed by others may change from visit to visit – it is prudent, therefore, to ensure not only that changes in medical his- tory (including medication) are regularly checked and updated, but also that this fact is clearly recorded as a dated entry in the patient’s clinical notes. page 13DTß Don’t read this... An Xtraordinary Indemnity Programme for the Whole Practice Lower professional indemnity subscriptions Free personal indemnity for every dental nurse and/or dental technician you employ for both clinical negligence and professional matters Free Indemnity for practice managers and receptionists Dispute resolution assistance for disputes between professional colleagues Free annual subscriptions to a comprehensive online information resource including a wide range of business and healthcare legislation and regulatory requirements CPD for the whole dental team Employment law helpline Practice management and clinical audit tools to make your practice safer, more easily managed and more successful For more information go to www.dentalprotection.org/uk/dplxtra or call our Membership Helpline on 0845 718 7187 ...unless you are interested in: 2453 DPL ad A4:Layout 1 10/08/2009 09:18 Page 1