Dentistry post COVID: The personification of risk

On the day of the tenth “clap for carers”, the Chief Dental Officer has suddenly given dentistry in England the green light.  From speaking with colleagues, this has come a bit out of left field and there will now be a frenzy of planning activity to facilitate a safe return to work.

How do we define work as “safe”?

For many of us, the practice we left behind in mid-March will be a world away from the one we will return to.  We must organise our resources (staff, equipment, protocols etc) to address these new challenges.  The added difficulty is that we must not only do this at a distance, but also play this new “game” without previous experience, a visible opposition, a clear rule book and yet with multiple (self-appointed) referees.

The discomfort of risk

Undoubtably risk can make us all feel uncomfortable.  The level of discomfort is defined by many factors: the degree of risk, its implication and our own perceptions of the potential harm that might be caused.  In my opinion, understanding (and embracing) the individuality of risk is the key to “new normal”. 

The “known knowns” and the “known unknowns”

With the emerging data on the transmission and consequences of COVID-19 we can inform our discussions on appropriate work-based precautions.  We can reduce risk using science and common sense to define AGPs, select appropriate PPE, write protocols.  What we cannot (ever) do is eliminate risk entirely.

Taking ownership

My observation over the last few years is that patients (and clinicians) have become increasingly intolerant of risk.  We quote complication rates for specific populations in the consent process.  There is a lot of nodding.  Signatures are obtained.  The lawyers are satisfied.  Problems happen to other people – until they happen to you as an individual.  As always, the treatment strategy of least risk is no treatment at all.  As soon as they leave the relative protection of their own homes, patients accumulate risk.  On the journey, in the waiting room, during treatment, on their way home.  By engaging in the process, the patient owns at least part of the risk.  Ensuring that they understand this is fundamental to moving forward.  In the post-COVID era, as individuals, we are going to have to take personal responsibility for ourselves in a way that we never had to before.  And at times, that is going to feel very uncomfortable.