Angela Harkins explains that dental professionals’ responsibilities to a patient can sometimes go beyond providing treatment.

Sometimes, even experienced dentists will encounter situations that are unfamiliar and it can be difficult to know what the best course of action is. In particular, vulnerable patients can present specific dentolegal challenges, such as whether to disclose confidential information and what your safeguarding responsibilities are.

In its guidance on child protection and vulnerable adults, the GDC states: ‘You must raise any concerns you may have about the possible abuse or neglect of children or vulnerable adults. You must know who to contact for further advice and how to refer concerns to an appropriate authority such as your local social services department’ (principle 8.5.1).

The following case study illustrates some of these challenges.

Case study

A 15-year-old patient and his mother attended an examination with a newly qualified dentist. During the appointment the dentist noticed scars on the patient’s forearms. When asked, the patient said he had been self-harming and gave the dentist permission to speak to his mother about it.

When the dentist did so, the patient’s mother became very upset, saying she sometimes feared for her own safety because the patient’s behaviour was erratic and he sometimes became violent at home.

After taking advice from the DDU, the dentist reported the discussions to the safeguarding lead at the practice, who in turn reported the concerns to social services as well as the Child and Adolescent Mental Health Team. Social services confirmed that the family were known to them already, but said they would provide extra support for the family due to the violent behaviour of the teenage child.

Issues surrounding confidentiality

All dental professionals must keep patients’ information confidential and only use it for the purpose for which it was given. In the case study above, the dentist acted in line with GDC guidance by asking the patient’s permission to discuss his self-harming with the mother.

Generally, patients, including those under 16 who are deemed mature enough to make decisions about their care, should be asked for permission to share their information. However, in exceptional circumstances you may be justified in discussing confidential information about a patient with others, if doing so is in the best interests of the patient or in the public interest.

It may be possible to break confidentiality if you believe a patient is putting their own safety or that of others at serious risk, even if a patient declines to give consent. You should tell the patient you’re going to do this, unless you think this information is likely to lead to the patient or someone else suffering harm. Make sure you clearly record the relevant discussions you have with the patient, and your justification for breaking patient confidentiality.

Safeguarding policy

All practices are required to have a safeguarding policy in place to help protect children and vulnerable adults. There should also be a safeguarding lead within the practice, who is the person responsible for making sure the safeguarding policy is adhered to.

If you encounter a situation where you are concerned about a vulnerable person, you should contact the practice’s safeguarding lead and check your concerns have been properly actioned.

Unfortunately, instances of abuse and neglect are more common than we may think. As dental professionals, we have an important role to play in safeguarding children and vulnerable adults, and we should be able to recognise potential signs and have the courage to ask questions when we do. 

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