RESUMEN
The character of a consent for treatment is not a mere hobby for lawyers; it also has consequences in daily practicein the Netherlands, particularly if it concerns questions of who should prove what in proceedings. In general, consent agreements can be divided into an obligation to achieve results and an obligation to use reasonable endeavours. In oral healthcare, there is usually a question of an obligation to use reasonable endeavours, in which professional standards must play a leading role in the behaviour of the dentist; and here there have been a number of recent developments, such as an increase in the number of (clinical) guidelines and the acceptance of wish fulfilling medicine, under strict conditions. It is concluded that recent developments in the dentist's requirement to provide evidence in proceedings have definitely not made things simpler.
Asunto(s)
Medicina , Odontólogos , Humanos , Consentimiento Informado , Países BajosRESUMEN
Most patients who file a formal complaint against a dentist do so by way of the law concerning complaints. In 2017 the law concerning complaints was changed radically, with the intention of making the law easier for the patient to make use of and providing the patient with a financial settlement. This article considers the extent to which the possibility of being compensated has had the effect of encouraging patients to file claims in the case of the Royal Dutch Dental Association (KNMT), the complaints service with which most dentists are associated. The article also considers whether the new law has made the process of filing a complaint more readily accessible. Finally, if the law of complaints has become more appealing for patients to make use of, one could imagine that fewer cases would find their way to the disciplinary board. For that reason, the number of disciplinary complaints in 2017 is compared to the number for 2016.
Asunto(s)
Legislación en Odontología , Mala Praxis/legislación & jurisprudencia , Satisfacción del Paciente , Relaciones Dentista-Paciente , Humanos , Países BajosRESUMEN
Judges up to and including the Law Lords (Supreme Court) and the Central Disciplinary Tribunal for Healthcare in the Netherlands do not consider guidelines to be optional. This offers security to patients and dental care professionals. But a field of tension can exist between, on the one hand, a patient's right of self-determination and the dental care workers professional autonomy and, on the other, a guideline. This field of tension can be resolved by first limited testing of the acceptability of the goal of care desired by the patient, taking into consideration at the same time professional autonomy; and, subsequently, by selecting the most effective treatment for achieving this goal of care on the basis of 'evidence'. With respect to the current definition of guidelines for clinical practice, this means that patients and healthcare workers explicitly acknowledge that they have been able to agree on a goal of care that deviates from the ideal. In this way, a judicially responsible balance is achieved between the right of self-determination and professional autonomy, on the one hand, and, on the other, the desire for evidence-based treatment and a limitation on unaccountable variation in treatment and transparency of care.
Asunto(s)
Odontología/normas , Derechos del Paciente , Guías de Práctica Clínica como Asunto , Autonomía Profesional , Humanos , Países BajosRESUMEN
In contrast to the law governing complaints and to disciplinary law, a civil law judge can sentence dentists to the restoration of all damages to patients. For this to happen, there has to be evidence of damage, responsibility and a causal connection. For the assumption of responsibility as well as a causal connection, an important question is whether a dentist has violated a relevant guideline or protocol. Moreover, dentists are not only responsible for their own mistakes, but also, in principle, for those of their employees. Depending on the situation, dentists can also be held accountable for the mistakes of a dentist who is working in their practice on a self-employed basis. Dutch dentists do not yet have to fear American situations', because damages awarded in The Netherlands are still relatively low.
Asunto(s)
Legislación en Odontología , Responsabilidad Legal , Mala Praxis/tendencias , Humanos , Jurisprudencia , Legislación en Odontología/tendencias , Mala Praxis/economía , Mala Praxis/legislación & jurisprudencia , Países BajosRESUMEN
The law promises patients a readily accessible means of filing complaints. Healthcare providers are therefore required to adopt regulations governing complaints which satisfy a number of conditions. Most dentists choose to adopt the regulations which have been established by their professional organization. In addition to handling complaints, there is also a provision for mediation, which is often used by patients. Mediation appears, then, to be a successful provision. Many complaints have their origin in insufficient knowledge of healthcare legislation and patients' rights legislation. This demonstrates that more attention should be given to these subjects in educational programmes and programmes in continuing education. The present law governing complaints is expected to be replaced this year by a new, more comprehensive law in which considerable attention will be devoted to the quality of care as well as to complaints. It seems likely, however, that the new law governing complaints will damage the effective manner in which patients' complaints are dealt with in dentistry today.
Asunto(s)
Odontología/normas , Odontología General/legislación & jurisprudencia , Legislación en Odontología , Satisfacción del Paciente/legislación & jurisprudencia , Odontología/estadística & datos numéricos , Odontología General/normas , Odontología General/estadística & datos numéricos , Humanos , Legislación en Odontología/normas , Legislación en Odontología/estadística & datos numéricos , Países BajosRESUMEN
Disciplinary law can be seen as an element in the system that protects the quality of dental care and in that way helps to maintain the high level of trust which the public has in the profession. A disciplinary court case is regarded by dentists as very taxing. This is in part a result of unfamiliarity with the procedure. The procedure is also feared because of the publicity it attracts. The publicity is partly inherent in the goal of the disciplinary law. To some extent the publicity seems to be taking on the character of 'trial by media'. Questions can be raised with respect to this latter development, regarding, for example, the use of anonymity by journalists; the impact of publication, which is partially dependent on other news-worthy events; and the impact of the publication of reprimands versus the most severe sanction.
Asunto(s)
Relaciones Dentista-Paciente , Odontólogos/psicología , Jurisprudencia , Legislación en Odontología , Atención Odontológica/legislación & jurisprudencia , Humanos , Mala Praxis/legislación & jurisprudencia , Medios de Comunicación de Masas , Países BajosRESUMEN
The extent of the responsibility to provide care which a dentist bears depends on whether a patient is registered with the dentist's practice. A dentist has the freedom not to register a patient with his practice, provided he does not violate the anti-discrimination laws or a cooperative professional agreement which the dentist has signed. No conditions are applied if a patient wishes to withdraw his registration, or a registration is withdrawn by mutual agreement. If a dentist wishes to terminate the treatment agreement unilaterally, this can only be done if serious reasons for doing so can be identified. The reasons for termination which will be accepted by disciplinary boards as serious depend very much on the conditions of the specific case. In cases of the unilateral termination of a treatment agreement on the part of a dentist, given the serious reasons for doing so, it is usually necessary for a dentist to take into consideration various requirements for careful conduct.
Asunto(s)
Atención a la Salud , Relaciones Dentista-Paciente , Accesibilidad a los Servicios de Salud , Legislación en Odontología , Actitud del Personal de Salud , Atención Odontológica/psicología , Odontólogos/psicología , Humanos , Países Bajos , Pase de GuardiaRESUMEN
The right to confidentiality and privacy is established in various laws and in many cases the violation of these laws provokes a reaction in the form of severe sanctions. Nevertheless, patients complain relatively seldom about violations ofprivacy laws by dentists. The right to privacy consists of a requirement of confidentiality on the part of those carrying out treatment and the patients' right to be treated without being observed by third parties. 'Third parties' do not include those involved in the treatment or someone who represents the patient. The right to confidentiality can be violated if a patient grants consent, in cases of a legal requirement or in cases ofa conflict of requirements. A separate regulation exists concerning the confidentiality and privacy of patients in the context of scientific research.
Asunto(s)
Confidencialidad/legislación & jurisprudencia , Legislación en Odontología , Derechos del Paciente , Privacidad/legislación & jurisprudencia , Confidencialidad/psicología , Investigación Dental , Relaciones Dentista-Paciente , Odontólogos/psicología , Humanos , Países Bajos , Privacidad/psicologíaRESUMEN
When minors are treated, a complex triangular relationship can emerge among dentist, patient and the individual legally responsible for the patient. Generally speaking, both parents are those legally responsible for a child. This might not be the case if the parents are not married to each other or have divorced, or when there is a question of a child protection ruling. The governing rule is that dentists are required to honour the obligations to the legal representatives thatfollow from the patients' rights concerning the treatment of children under the age of 12. In the case of patients between the ages of 12 and 16, dentists are required to act in accordance with their obligations to both those legally responsible and to the patients. Finally, in the case ofpatients who are 16 and older, dentists are required to act only in accordance with their obligations to the patients. There are, however, various exceptions to this governing rule. One of the most common examples is the patient who is a minor of 16 or older who is unable to determine what is in his own best interest. That criterium is also used in determining the capability to give informed consent in adults.
Asunto(s)
Consentimiento Informado de Menores/legislación & jurisprudencia , Consentimiento Informado/legislación & jurisprudencia , Legislación en Odontología , Adolescente , Adulto , Niño , Atención Dental para Niños/legislación & jurisprudencia , Atención Dental para Niños/normas , Humanos , Competencia Mental/legislación & jurisprudencia , Países Bajos , Consentimiento Paterno/legislación & jurisprudenciaRESUMEN
Dutch law requires every healthcare provider, which obviously includes dentists, to maintain health records. Most of the rules governing the health record requirement are in the Law of Agreement to Medical Treatment (WGBO). And, as is often the case with the law, interpretation is left to the (disciplinary)judge. There is, in fact, a considerable amount of legal precedent concerning what information belongs in the health record. It is not uncommon for a dentist to be on the losing side in a legal proceeding because his defence is not supported by the health record. And if it becomes clear that (a portion of) the health record has been destroyed, despite the legal requirement to maintain records, in this too the dentist can count on little sympathy from the judge. In a recent judgment, the Central Disciplinary Committee was more severe than ever- with far-reaching consequences for the relevant dentist.
Asunto(s)
Odontología/normas , Legislación en Odontología , Sistemas de Registros Médicos Computarizados/legislación & jurisprudencia , Sistemas de Registros Médicos Computarizados/normas , Humanos , Jurisprudencia , Responsabilidad Legal , Países BajosRESUMEN
The relationship between a dentist and his patient is based on trust. The principle of informed consent contributes to the quality of that relationship of trust. According to the professional standards for such a relationship, it is up to the dentist to make sure that the patient is well informed. Reliable information is necessary if the patient is to be in a position to give his or her consent for treatment. The Dutch Law of Agreement to Medical Treatment (WGBO) provides aframework for informed consent. Disciplinary judges establish the scope and if necessary the limits. It is clear that, among other things, not defining the risks beforehand can be the basis for a (disciplinary) complaint. Determining the requirements of informed consent calls for familiarity with the law and communication skills. Programmes in dental education ought to devote more attention to this issue.
Asunto(s)
Relaciones Dentista-Paciente , Consentimiento Informado/legislación & jurisprudencia , Legislación en Odontología , Comunicación , Humanos , Países Bajos , ConfianzaRESUMEN
With respect to disciplinary and other complaints, it is apparent that they are often based on a difference of opinion concerning professional standards for oral healthcare. Relevant differences of opinion can arise between dentists, but also in the dentist-patient relationship. A large degree of the ambiguity which lies at the basis of such discussions could be removed by the use of clear clinical guidelines. Since these are still scarce in oral healthcare, a dentist will have to rely on adequate communication to avoid conflicts. A dentist must be aware of possible conflicts of interest and of the characteristic range of the professional standards for oral healthcare. Departing from that range at the request of a patient is not an option.
Asunto(s)
Comunicación , Relaciones Dentista-Paciente , Odontología/normas , Legislación en Odontología , Salud Bucal/normas , Comprensión , HumanosRESUMEN
A dentist should deliver oral healthcare according to the professional standard. This legal determination is not very distinct and ought to be made more specific. Guidelines, protocols, and indicators play an important role in this respect, but are scarce in oral healthcare. Provisionally, judgements of discipline and complaints committees are heavily relied upon. Those judgements indicate what efforts, and in some cases even what results, a patient could have expected from a dentist in the specified conditions.
Asunto(s)
Atención a la Salud/normas , Odontología/normas , Legislación en Odontología , Competencia Clínica , Humanos , Competencia ProfesionalRESUMEN
Dentists have a duty to provide care. This duty, which interestingly enough has a limited legal basis, is for the most part given form by jurisprudence. In that process, the disciplinary judge and the grievance committees pay attention especially to 2 rules of conduct and 1 regulation governing practice. In practice, it appears to be the case that rules of conduct and regulations do not always provide an unambiguous guide. The domain within which dentists operate is striking. The availability and the accessibility of dentists are not always harmonious with the personal perception of a patient. It is sometimes difficult to find a proper balance between what is a dentist is able to manage and what a patient wants.
Asunto(s)
Atención a la Salud , Accesibilidad a los Servicios de Salud , Legislación en Odontología , Servicios Médicos de Urgencia , HumanosRESUMEN
Regulations which have been established by the professional community or by an organization of which a dentist is a member (self-regulation) have a more significant legal effect on dental care than many dentists realize. A dentist can only deviate from these regulations if he does so when motivated by the patient's best interests. Self-regulation can be relevant at the level of the professional community, the organization or the individual dentist. Self-regulation should satisfy a number of criteria if it is to be applicable to an entire professional community, specifically: it must be sufficiently authoritative, it must harmonize with existing laws and regulations and it must be easily accessible to both professionals and patients. The application of self-regulation is sometimes limited to a specific group, for example dentists who have signed a working agreement with a certain health insurance provider or who work in a certain institution. Self-regulation can entail liability not only on the part of the healthcare professional but also, in theory, on the part of those who establish the regulations.
Asunto(s)
Atención a la Salud/legislación & jurisprudencia , Odontólogos/psicología , Legislación en Odontología , Autonomía Profesional , Atención Odontológica , Humanos , Países Bajos , Pautas de la Práctica en OdontologíaRESUMEN
A regional disciplinary board censured a dentist who allowed someone without proper authorisation to carry out a procedure and that judgement was the motivation for providing some clarification concerning the Dutch law. In the Netherlands, more than in most other countries, a relatively large amount of freedom is given to people who are not medical doctors to carry out dental procedures. This freedom does, however, have its limits and they are established in the law governing the registration of healthcare professionals (in the BIG-register). The central requirement in this law is competence. In addition, the law makes a distinction, at the present time, among a group of healthcare providers who are authorised to carry out, independently, restricted treatments (dentists), a group of healthcare providers who are authorised to perform certain functions (dental hygienists), and a group who are not authorised. Provided they satisfy legal requirements, non-authorised individuals can also carry out restricted treatments. In the future, this system might be breached, in the sense that the requirementfor authorisation will lapse.