All employers, business owners, contractors and employees have an obligation to create and maintain a safe working environment.  And to do this we all need to think about what makes our workplace unique in terms of the risks and the strategies needed to keep it safe.

There are a few ways in which osteopathy clinics can pose risks to the personal safety of practitioners, other people who work there and patients.  One on one consultations mean that the osteopath is always alone with a patient.  Small practices can lead to osteopaths being the only worker present in a clinic.  And the varied hours of clinics will often see practitioners working late at night.

Below are some tips to help you create a safe workplace for everyone who comes into your practice.

• When booking in a new patient who you know nothing about, consider booking them in during a busy time of the day when there are other staff around, rather than when the osteopath will be in the practice alone.

• If you have a patient who for any reason raises some red flags in terms of the osteopath’s comfort levels, only allow them to book in when there are others in the practice.

• When an osteopath is practicing in the evening and is the only person working at that time, consider locking the front door to the practice.  If you do this, explain to any patients inside what you’re doing and why.  And consider your process for other patients who’ll be arriving.  Will you let them know the door will be locked and that they’re to wait outside till you’re ready for them?  Maybe you’ll only lock the door once the final patient for the day has arrived.

• Installing a buzzer on the front door notifies you when it’s been opened, thereby allowing you to be sure when people are entering your practice.

• Consider installing a reception area camera and post clear signage so anyone who enters understands they’re being filmed and will be identifiable.  Don’t use cameras in actual treatment rooms.

• Consider walking patients and colleagues to their cars when it’s late, however be sure to consider your own safety when doing this.  Provide clients with advice on safe places to park.

• Always lock your car doors as soon as you get in, and keep in mind criminals can approach from varying angles so they may be in your blind spot.

• Unfortunately, osteopaths sometimes will be faced with the challenging situation of a patient asking them out or suggesting a romantic relationship begin.  Often when this happens, the patient isn’t aware that relationships between practitioners and patients aren’t allowed.  Thinking about this situation before it occurs and having a plan for what to say and do can make it easier for the osteopath to deal with it immediately and professionally. If patients appear reluctant to accept your refusal, make sure they’re booked when others are on site, or with other practitioners in future.

• If the practice is in the home of the osteopath, have processes in place to separate the living space from the practice and therefore protect the privacy and safety of the practitioner and their family members, especially children.  And be aware, family members may also breach a patient’s privacy or modesty so ensure everyone in your household understands the rules.

• Keep records of any uncomfortable, challenging or threatening behaviours from patients, and be sure to save anything that’s received via text or email.  This information is to be recorded in the patient record.  The details on what occurred can be brief yet must be professional, keeping in mind records can be seen by others.

• Don’t contact patients via your personal email or mobile phone or provide these details to them. If you need to contact them while off-site, put your phone on “No Caller ID” so they don’t have access to your phone number.  If you leave a voicemail message, ask the patient to call the clinic phone, not your mobile.

• Have a practice policy that advises against practitioners connecting with patients on social media as these connections can contribute to the blurring of professional boundaries.  And be sure to understand the privacy settings of any social media platforms used.

• Discuss any challenging or awkward situations with your colleagues or other osteopaths and even other healthcare professionals.  This not only provides support when dealing with challenging situations, it also can provide additional tips for how to manage these situations.

• If you’d like some assistance to deal with a challenging patient who’s making you feel uncomfortable or threatened, contact Osteopathy Australia for advice and support.

It’s important to remember that work, health, and safety laws apply to everyone in the business, including contractors, not just the business owner. A safe work environment is in everyone’s best interest so open communication about any concerns is the best way to protect all staff members. 

There are an increasing number of dental services available which are direct to the consumer, meaning the consumer hasn’t consulted directly with a registered dental practitioner.  While the convenience of these services is obvious, they aren’t without risk for both the consumer and any registered dental practitioner involved.

These direct services are available for several dental treatment areas such as orthodontic aligners, splints and sleep appliances.  These services can be initiated by the consumer creating their own impression using materials and information provided to them.  In other cases, the patient may have a digital scan carried out by the service provider at a designated location (shopfront or pharmacy), often by someone who is not a registered dental practitioner.  Following this, a treatment plan is developed and the device(s) required will then be provided to the patient for use.  Some of these services also offer mechanisms for remote supervision of treatment progress by a dental professional.

One of the concerns with this type of treatment model is that other dental issues, not directly related to the appliance, may not be detected due to the patient not being regularly assessed and treated in-person by an appropriately registered dental practitioner.  There are also concerns about how patient suitability (or standard of care case selection) is determined.  While some companies providing these services do have a process of assessing the suitability of the appliance for each patient, this is often done by the patient completing an online assessment form themselves; therefore, there is no assessment for suitability by a registered dental practitioner.

There may be occasions where a dentist, who isn’t involved in this treatment model, has a patient ask them about their views on it or asks them for support in completing forms required to purchase one of these devices.  Dentists should be aware that if they provide clinical advice, they are involved in the treatment.  It’s therefore recommended that dentists contact their ADA Peer Advisor (NSW/ACT) or Community Relations Officer (Victoria, South Australia and Tasmania) if they find themselves in this situation so they can obtain advice on how to best manage this situation.

Dentists who choose to participate in these treatment models need to understand and appreciate their level of responsibility and possible liability.  Regardless of whether or not a dentist has seen or consulted with the patient themselves directly, involvement in design of such appliances or other aspects of their provision and use may be deemed by regulatory bodies to be provision of a dental service.  Registered practitioners, when providing a dental service, must ensure their professional obligations are always being met. 

If a consumer is dissatisfied with the outcomes of their treatment and they’re aware of a registered dental practitioner who was involved in their treatment in some capacity, they have the same rights as other patients to formally complain to regulatory authorities or make civil claims about the treatment provided by this practitioner.  To defend against allegations of wrong-doing, this practitioner would need to show that:

• the treatment and/or advice they provided was to the professional standard expected;
• they are appropriately qualified and experienced to be providing that treatment and/or advice;
• the treatment and/or advice was clinically justified;
• the patient was aware of the risks, expected outcomes and limitations of the treatment; and
• detailed clinical records have been maintained, showing exactly what was done and why.

It is therefore strongly recommended that any registered dental practitioner choosing to become involved in any capacity in providing treatment through this direct model considers the risks involved and be certain these risks will be appropriately managed.

Guild Insurance Limited ABN 55 004 538 863, AFS Licence No. 233 791.  This article contains information of a general nature only, and is not intended to constitute the provision of legal advice. Guild Insurance supports your Association through the payment of referral fees for certain products or services you take out with them.