spring edition 2012
mips student review
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nothing but the t(r)ooth… Dr Gerard Clausen
An honest, self-critical and factual evaluation of treatment performed by the treating practitioner often determines the conduct, complexity and cost of managing a dental claim. In many cases MIPS receives a notification when a practitioner receives a complaint, or a request for financial consideration from a patient. The first step undertaken by a MIPS clinical advisor is usually to contact the member and seek his/her version of events, particularly the specific details of treatment surrounding the case. This information may, support defence of the practitioner’s position rather than moving to consider whether to move to an offer to the patient of a refund, or for funding subsequent treatment. The key element in this significant decision-making process will be the account the treating member gives of their management. Concurrently the treatment records are also requested to evaluate their content, quality and whether or not they support and confirm the verbal assertions for such matters as explanations given, treatment options discussed, consent and the clinical procedures performed. Truth is the pivotal aspect in this entire process, and a recently settled case illustrates the importance of this. The matter involved a fractured endodontic instrument in a maxillary molar tooth. The patient had seen her dentist twice, once for an emergency “open and drain”, and subsequently to formally commence endodontic management of tooth 26. After the second visit the practitioner indicated to the patient that whilst treatment was progressing well, it was slightly more complex than initially envisaged, and to get
the best result referral to a specialist endodontist would be the preferred option. On the basis of this explanation and the information provided, the patient was happy to comply with the recommendation, and a referral was made. The patient was subsequently most upset when the endodontist, during the initial visit, detected a fractured file and appropriately disclosed this to the patient. The aggrieved patient immediately contacted the initial treating dentist and sought funding of the difference between the proposed cost for endodontic management of tooth 26 by the endodontist, compared to the original estimate for endodontic treatment with the general dentist. At this stage, the matter could have been resolved for a small cost. In fact, the difference between the endodontist’s proposed fee, which included removal of the fractured instrument, and the original fee quoted was several hundred dollars. The critical element in making a decision in this matter is, of course, whether it is accepted that the treating general dentist did indeed fracture the file and did not inform the patient of this. Naturally, if there was not a fractured file, or the incident had occurred elsewhere, there would be no liability attaching to the member. On receipt of the claim by the patient the member then notified MIPS, following which a dental advisor made telephone contact. During this discussion the member was not only adamant that they
had not broken an instrument in this case, but also indicated that they were so sure of this, they had called the patient on receiving her complaint and demand, and informed her that she was mistaken, and would certainly not consider acceding to her request under any circumstances. The member agreed to send their records and radiographs to MIPS for evaluation. The rest, as they say, is history. A specialist endodontist, who is a MIPS dental advisor, reviewed the radiographs and in his opinion, the fractured file segment could be radiographically detected. When the treating dentist was informed of this he did concede that there was “something visible”, which he had indeed seen, but he was not absolutely sure he could identify it as a file. This then raises the unfortunate question of, “well, what other metallic object could it possibly have been?” The object was a fractured instrument. Had the dentist known of it, but hoped that the endodontist would either not recognise the instrument fragment, would remove it during the course of canal debridement, or would bypass the segment? Were they hoping to deceive the patient, the endodontist and the specialist dental advisor, and not be detected? The outcome of this matter was that the already upset patient, after being firmly told by the dentist that her request for funding was denied, then sought legal advice. The small matter which could have been expeditiously resolved now escalated significantly. Two years elapsed before the file could be closed, with a settlement figure many times the small amount originally requested, considerable continued …
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legal costs which had to be borne by the insurer on the member’s behalf, and countless days spent by the member in providing reports and attending hearings. The member was also subject to disciplinary action and then had to undertake numerous training
courses in endodontics, at their own expense, before being permitted to continue to provide endodontic services in their practice.
admission of the undeniable facts of the case. Perhaps, ‘Honesty is the best (Indemnity) Policy’ after all.
And to think...all of this could have been avoided by a simple, honest
2012 Academic year! Congratulations! It’s that time of the year again! Some of you might have just completed your first year of medical or dental school; some of you are well on your way, while for others this is the end of your studies as you embark on a great journey ahead on your chosen career path. Graduating Student Members As a graduating student member of MIPS, you need to apply for MIPS new graduate membership to access a number of additional membership benefits. For medical and dental new graduate members, MIPS membership is FREE for the rest of the membership year (to 30 June), and provides the peace of mind needed to get settled and concentrate on the job ahead. As well as providing a range of member benefits to new graduate medical members we also provide in-house training and information sessions in your hospitals and provide support to RMO societies around Australia. New Graduate dental members, enjoy benefits that include meeting professional indemnity insurance requirements for your AHPRA registration in addition to a number of other benefits. All of our medico-legal adviser staff were once new graduates, so MIPS medico/dento-legal advisors are well placed should you need any advice or assistance. If you have been a student member of MIPS during the
course of your study, you will be aware of the additional membership benefits that included discounted text books, IT equipment and of growing relevance - practice equipment. In addition ‘graduate’ members of MIPS who have been members for 3 months or more are able to access a discount of up to 10% on the recommended retail purchase price of new VW or Skoda vehicles.
Risk management is a key benefit of your MIPS membership. Remember MIPS advisors are experienced health professionals who are available 24/7 to assist you with advice. Remember the only silly question is, the one you don’t ask!
New Graduate membership also provides you with personal accident cover, and for those dental graduates going into private practice, practice entity cover. The unique benefit of MIPS protections continues with your progression to graduate member. Please note that MIPS cover does not impose a sub limit restricting the level of legal fees for investigations or proceedings, nor do we charge a new graduate ‘membership fee’. Of course you are free join to any other organisation while a member of MIPS and likewise are free to apply to join MIPS as a new graduate member even if already covered by another indemnity organisation.
congratulations to our recent Kindle winner - dental student Christopher Tay! (Oral health centre, University of Western Australia)
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University of Queensland and Griffith University Dental Schools do battle! In a bid to defend their schools, two teams came together on the 20th of July 2012, to battle for supremacy. MIPS dento-legal adviser and MC extraordinaire, Dr Gerard Clausen was called upon to present the evening as well as
Dr Gerard Clausen MIPS dento-legal adviser at the dental evening
adjudicate over the proceedings. The debate topic was, Is amalgam still the material of choice for direct posterior restorations? As the two teams went head to head, it was the University of
good to see everyone catching on the latest MIPS news!
Queensland that proved victorious against the Griffith powerhouse team and won the coveted giant chocolate frogs much to their delight!
the battle begins!
AMSA convention 2012 At the recent AMSA convention held in Perth in early July, Winthrop Professor, Dr Fiona Wood was the key note speaker. Dr Wood came to prominence with her burns related work in the aftermath of the Bali bombings. Her dedicated research into synthetic skin and skin grafts has aided hundreds of people survive horrific burns in shorter timeframes and with far less scarring. Around 800 medical students at the convention
benefitted greatly from Dr Wood’s experience and research that she has tirelessly amassed over her years of work and study. Her great sense of humour kept her presentation lively and enthusiastic audience engaged. Dr Wood was quick to impart some of her key tips in raising a brood of five and she most definitely would have been an inspiration for some in the audience with dreams of becoming skin specialists.
MIPS Liaison Officer And rew Hollier and Dr Fiona Wood at the AM SA convention
2013 elective alert! Some of you might be thinking about what you would like to do for your upcoming 2013 electives, please visit the ‘my membership’ portal at mips.com.au and see how MIPS and Work the World can help you plan for your elective overseas.
1800 061 113
www.mips.com.au