Welcome to the June 2024 edition of the ASO Industry Newsletter.
In this edition, we are excited to share some of the most thoughtprovoking presentations from the recent 29th Australian Orthodontic Congress including “What is consent, and how do I know if I have it?” by Dr Annalene Weston, as well as one of my favourites –the Stanley Wilkinson Oration by Dr James Muecke AM, who spoke about the role of diet in diabetes and its impact on eyesight.
In addition, we are pleased to present Part 2 of “Tips for launching a successful practice” for recent graduates, focusing on practical tips and advice to grow and successfully manage your practice.
The ASO is looking forward to welcoming members to the 2025 ASOFRE Foundation Meeting in Hobart from 28th – 29th March next year, as well as the 2026 Australian Orthodontic Congress in Melbourne from 20th – 23rd May – please save these dates.
Finally, I would like to acknowledge the industry partners featured in this publication – your support has been pivotal in helping us develop an informative and engaging publication.
We hope you enjoy the magazine.
Dr Francis Wong
ASO Federal Treasurer
Feature
Solventum Webinar with Dr Faye Goodyear..........................................................02
Guest Article
Dr Annalene Weston: What is consent, and how do I know if I have it?............................... 03
ASO Adelaide 2024
Program highlights: exclusive recordings
•Stanley Wilkison Oration: Dr James Muecke AM........................................08
•Aligner Biomechanics: Dr Willy Dayan...........................................................10
OrthoGrad Insights
Tips for launching a successful Practice (part 2) •How to market and bring in new patients to your practice ..............................................................13
Foralleditorialoradvertisingenquiries: (02)99657250orcommunications@aso.org.au
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Dr Faye Goodyear B.D.A. (Lond.), B.Sc. (hons) M. Sc. (Lond.), M.F.D.S. R.C.P.S. (Glas.) M. Orth. R.C.S. (Edin.)
Dr Goodyear gained her Dental Degree from Guy’s Hospital London, her Membership to the Faculty of Dental Surgeons in Glasgow and completed her Masters in Orthodontics and a BSc (Hons) degree in psychology at the University of London.
After a decade of both private general practice and public health experience, Faye bought Suite 16 of Toowong Terraces in 2016 and redesig ned the new contemporary fit out herself with the help of her father, a retired architect.
With a taste for adventure (having been a bungy jump instructor in her twenties), Faye enjoys getting out on her bike and is a keen competitive road cyclist and she can be found riding early most weekday mornings.
When: 12th June 2024
Time: 7 PM AEST(SYD/MEL/BNE)
Duration: 1 hour
What is consent, and how do I know if I have it?
Dr Annalene Weston
Senior Dentolegal Consultant and Dental Advisory Team Lead at Dental Protection
Australia
The Dental Board of Australia defines consent in the Code of Conduct as ‘a person’s voluntary decision about healthcare that is made with knowledge and understanding of the benefits and risks involved'1 and goes on to expand on the considerations a clinician needs to have when obtaining consent. While I would strongly encourage you to read this, it can also be helpful to consider consent through a variety of other lenses to ensure that we understand what it is, how we document it, and critically, how we know if we have it.
Consent is a conversation, not an administration process. During that conversation the clinician needs to convey to the patient the nature and purpose of the treatment proposed, any meaningful alternatives (including the alternative of no treatment where appropriate) and the risks and warnings associated with each of these options. There needs to be a lightbulb moment whereby the patient understands what the treatment really means for them, the costs of treatment, and any additional costs that may be incurred if the treatment does not go to plan.
The conversation cannot meaningfully take place until the clinician knows the patient sufficiently to understand their values and treatment wishes. It is a recipe for disaster to treat a patient before that as most complaints arise from ‘treating strangers’. Suffice to say, achieving consent is not as easy as whipping out a six-page document and asking the patient to ‘sign here’.
From a legal perspective, for a conversation of consent to be valid, there must be three components in place.
1.Information
2. Capacity
3. Voluntariness
There are three standards of information that need to be considered; the professional standard which is the information WE feel a patient needs to know about their care, the objective standard which is what an ‘average’ patient would want to know about their care and finally, the subjective standard which is the specific information that a particular patient would want to know about their treatment based on their unique needs.
The latter is the tricky one and it led to the lead case of Rogers v Whitaker [1992] HCA 58-175 CLR 479 which put the concept of failing to warn
a patient of things of a material risk as a negligent act firmly on the map. 2
Never confuse the concept of ‘informed’ to mean ‘giving the patient a heap of information’ –the messaging needs to be MEANINGFUL to the patient, so they understand what it means to them. This was crystallised in the UK case of Montgomery 3
From a legal perspective, this means the mental capacity for a person to be able to make a decision about themselves. In dental matters, this means that the patient needs to understand what the treatment means for them, which alternatives (if any) are suitable, the likely consequences of proceeding with any of these treatments, and also the consequences of no treatment, known as ‘informed refusal’ – this can be particularly relevant in things like refusing x-rays.
Broadly, adults are assumed to have capacity unless determined otherwise, while young children are not, and require a substitute decision maker. Of note are teenage patients who can, in certain circumstances, be deemed to have capacity to make decisions about their own treatments.
The lead case relating to decision makers for minors is that of Gillick. A very helpful resource which discusses the case of Gillick, and decision making for minors in general, can be found here: https://www.dcssds.qld.gov.au/resources/ dcsyw/protecting-children/guide-for-healthprofessionals.pdf
There can be no consent in coercion. While we like to think we would never coerce a patient, it is important that we ensure that we are providing the patient with their options in a balanced and unbiased way – this is not always as easy as you would think.
Once the conversation of consent has taken place, it is prudent practice to check the patient’s understanding. This can be done by a simple retell e.g. “just to be sure I have explained this clearly, what do you understand your options to be… and what things was I worried about…?” Alternatively, for more complex cases, it can be helpful to refer a patient to an entity such as ‘Choosing Wisely Australia’4 for some guidance on questions they may wish to ask/things they may wish to consider.
(Continued on page 7)
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The last piece of the puzzle once the conversation has taken place, the patient has had sufficient opportunity to ask their questions, and these have been summarily answered, is documenting that consent was obtained. Consent forms can be helpful for this, but too much reliance on a piece of signed paper has led to the downfall of many practitioners when they find it to be a paper shield.
Contemporaneous documentation of the conversation of consent in the clinical notes, perhaps typed by the DA in real time while the clinician and the patient are talking, is a reasonably robust way of documenting consent, as it is time and date stamped. Remember to check what is written, and amend at that time if required, as amendments down the track (and after a complaint) cast a shadow over the practitioner’s honesty and integrity, and the veracity of the entry.
Consent will always be complex and multifaceted. Open communication with our patients and giving them the genuine ability to ask questions and
consider the information will stand a practitioner in good stead when it comes to ensuring valid consent was obtained. And, at this time, documenting in our clinical records remains the best way of evidencing anything.
References:
1. Ahpra & National Boards: Shared Code of conducthttps://tinyurl.com/j69tj7b7
2. A summary of the case can be found here https://pubmed.ncbi.nlm.nih.gov/11648609/
3. Montgomery v Lanarkshire Health Board [2015] AC 1430, [2015] UKSC 11- a helpful summary can be found here https://mcbridesguides.com/wp-content/ uploads/2016/09/montgomery-v-lanarkshire-healthboard.pdf
4. https://www.choosingwisely.org.au/
This article is produced by a third party (not the ASO) for guidance purpose only and is not a substitute for legal advice. Legal advice should be sought for individual circumstances.
Orator: Dr James Muecke AM
Dr James Muecke AM graduated with Honors from the University of Adelaide Medical School in 1987. Following his internship, James lived and worked as a doctor in Africa and subsequently as an eye surgeon in the Middle East, battling malaria, wild animals, and rebel soldiers. He founded Sight For All in 2008, turning his boundless energy into a fight against blindness in the Aboriginal and mainstream communities of Australia and some of the poorest countries of Asia and Africa. Sight For All’s comprehensive and sustainable projects are now impacting on the lives of over one million people each year.
His commitment to social impact and humanitarian endeavors has earnt him a number of awards including an Order of Australia in 2012, the Australian Medical Association’s President’s Leadership Award in 2013, and Ernst & Young’s Social Entrepreneur for Australia in 2015. James is Australian of the Year for 2020.
James is a researcher, a teacher, an author, a musician, a photographer, and a film producer, and uses his many skills to deliver passionate, fascinating, and at times confronting presentations about his life, his work, philanthropy, resilience and social entrepreneurship. A neurological condition impacting on his dexterity has forced James into a premature retirement from surgery. Not letting his disability slow him down, James has redirected his vigor to crafting films, and has a number of powerful documentaries under his belt and several compelling projects in production.
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Dr Dayan received his DDS in 1986 and his diploma in Orthodontics in 1991 both from the University of Toronto.
In addition to his private practice in orthodontics, Dr Dayan is also a clinical instructor of Orthodontics. His teaching expertise lies in areas of: Invisalign Aligner Biomechanics, Esthetic Adult Orthodontic Techniques, and Rehabilitative Orthodontics in preparation for Cosmetic Reconstructive Dentistry, Patient Interviews and Treatment Presentation Skills. He has been a guest lecturer at multiple conventions and meetings worldwide and continues to guest lecture at the Department of Orthodontics in Universities worldwide.
Dr Dayan became an Invisalign provider in the fall of 1999, has treated over 4000 of his own cases and coached over 25,000 ClinChecks on his coaching site. Dr Dayan is a registered speaker for Invisalign and currently teaches orthodontists internationally how to achieve excellent results in the most challenging cases.
Dr Dayan also coaches many clinicians about their own Orthodontic cases, helping them to customise their own orthodontic and ClinCheck treatment plans for their individual patients, through his website: YourOrthoCoach.com
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Dr Francis Wong ASO Federal Treasurer
If you’re thinking of starting a practice, you’re probably wondering how you’ll get new patients through the door, just like anyone else would when starting a new business. Similarly, if you’re buying out a retiring orthodontist, you’re probably thinking about how to increase the number of new patient appointments that have been declining over the last few years. On the other hand, if you’ve joined a busy, growing practice, then you probably don’t have to worry about new patients; it won’t hurt to read on for some of my thoughts about marketing though:
• Get to know your referral base. You might feel awkward initially about dropping in to see the general dentists in your area, but try to think of it in reverse – you’re really finding out more about them and their practice and what kind of patients they attract, rather than trying to ‘sell’ yourself. If the dentist is too busy to talk then offer to follow-up by making a lunchtime appointment another time. You really only need a handful of good referrers, not a monopoly over the whole area. And eventually, if you’ve done a good job with your referrer’s patients that they trust you with their own kids, there is no better endorsement.
• Being in a good location will go a long way to building a thriving practice. You don’t have to be next door to a school but being close to a
(Continued on page 14)
few of them will make it very convenient for our younger patients. Most of our treatments extend over a couple of years with multiple visits in between and parents will usually seek out an orthodontist close to their kids’ school, home, or place of work. No one wants to travel across town every 6 to 8 weeks for an orthodontic adjustment if there’s another way.
• Approaching the local primary school and offering to do an incursion to talk about oral health can be another way to get exposure without the stress of being bogged down with questions from parents or teenagers. You’ll need to take a long-term view as these kids won’t be ready for comprehensive treatment for a few years, but little kids love gifts, even if it’s oral care products packaged nicely in a Colgate pouch with your business card on the front.
• Have a simple website where people can find out about you and your specialist qualifications but keep it brief and relevant. Most people won’t spend more than a few minutes browsing your website and combing through lots of text. If you want to take it a step further, a couple of professionally-shot short video clips is a great way to grab people’s attention.
• Social media can be a powerful marketing tool but beware of the audience that you are
potentially targeting. You might also need to commit additional resources to monitoring and filtering what gets posted on your business profile and you need to decide whether this is worth the extra hassle. Fortunately, the ASO has done much of the groundwork in this space through the Public Education Program (PEP), which is ongoing. The strength of the ASO is the support it receives from its members and the PEP is just one initiative where the ASO is here to support the profession and your changing needs throughout your career.
• Whether you decide to offer free initial consultations is very much an individual choice. Some say it reduces a barrier to seeking orthodontic care, especially if you’re competing with lots of GP dentists in the area who do their own orthodontics; others say it attracts people who are just shopping around and it devalues the expertise of being a specialist orthodontist.
• Finally, my mentor once told me the best form of marketing is providing honest, good orthodontic treatment that your patient or their parent will tell all their family and friends about. No one ever asks which endodontist they went to for their amazing root canal, but parents will ask other parents during school pick-ups and drop-offs where they took their child to get their braces. If you also email them good quality before and after photos that they can access easily on their phone, then they will do the advertising for you with a swipe of their finger.
Dr Gosia Barley WA Councillor
Quite often, as graduates at a mature age, we are endeavouring on two completely new roles within our lives. One which comes with a threeyear training degree and the other with only a few parenting classes at best.
Not much can prepare you for your own individual journey, as a parent and a unique family. No doubt, the concurrent mountain of raising children whilst developing oneself professionally as a specialist, be it a principal or an associate, comes with a good dose of stress, uncertainty and often imposter syndrome on both fronts.
During my journey, I felt beyond my depths and
sought women in strong leadership positions, who could shed some light on how to do ‘it’, the elusive career and family balance. Truth be told, at the time there were not many in leadership within our country, in all facets of politics, health, media, private enterprise or government. I did however read an interview with Quentin Bryce, the then Governor-General of Australia where she stated “You can do it all, just not all at the same time”. We fulfill many roles as professionals, partners, parents, friends and daughters/sons, all which take time, care and looking after relationships. Be kind to yourself and understand that through the different stages of life and your professional development, the time and opportunity will change along the journey.
In the meantime, time is the greatest asset of all. Learn to value your time at work and at home, to try optimise your balance.
(Continued on Page 18)
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• A common feeling early in the piece is to commit to a significant amount of work, particularly whilst there is time. Without factoring in the “growth” in workload and the growing family commitments, consultants will often find themselves overcommitted and then needing to cut back.
Rather start as you mean to ‘maintain’ in terms of work days/hours.
• Scheduling and the use of office time is singlehandedly the most important factor of efficiency and your productivity.
• Be prepared to delegate parts of your role, those that others can do and at times do better than you.
• Think efficiency laterally and longitudinally i.e. work efficiently within your day but very importantly within the overall treatment plan. How many appointments did it take to get your patient from A to B, could you have done it better?
• Try finish your correspondence on the day and avoid taking work home.
The days are long but the years are short. You blink and they will be taller than you.
• You will never remember the banding or the amounts of them, but you will remember the assemblies, sports carnivals, parent helper duty and mother/father day celebrations. Schedule appropriately and call the school in advance for the dates.
• Be prepared to delegate your role too, it is hard to let go but it is good for the whole family unit, partner and grandparents included.
• Schedule time in your working hours/roster for administration, so that it does not encroach on your family time.
• Most of all, look after yourself and your health. You only get one shot in life and you are no use to anyone without it. The work will always be there.
Goodluck and as always, find time.
Dr Marcus Tod QLD Councillor
You have just worked tirelessly over three years intensively learning your orthodontic craft and now are somewhat suddenly on the other side with your newly minted degree. Some graduates may join a large group practice with a ready referral base while others will set out on their own path. Either way there is no escaping the fact that as a specialist you need to cultivate and maintain good relations with your referring dentists. There’s no cookbook approach to relationship building but here are some tips that may be useful.
• If you are new to an area or see a patient from a new referrer, make a time with the dentist’s receptionist to drop in to introduce yourself –even better if you have been referred an interesting case; you can take records to discuss your treatment and treatment philosophy. Take the opportunity to understand their interests within dentistry as well as gather some personal information.
• If a patient needs a referral to another specialist, such as an oral surgeon, call the dentist directly to ask about their preferred specialist. Most dentists like to be wellinformed of any secondary referrals so that there are no surprises at the recall visits.
• Document any cont act with your dentists –recording the date/time you visited as well as notes about what was discussed (including personal trivia like hobbies and family) and key staff you interacted with. Make a note to follow up with a chat/visit six to twelve months later.
• Host an education night inviting dentists and OHT’s to your office (or event space as you get bigger). You don’t need to use third party education providers, but it does help to offer topics that are relevant to general dentistry so if you are not confident in speaking yourself you may wish to invite another speaker from a different specialty (for example, an endodontist or even a physiotherapist speaking on TMD).
• Offer a new or existing referrer a “lunch and learn” session at their practice. If there is enough room, bring along some key members of your team for a more social vibe. Speak on an orthodontic topic relevant to GDPs such as early intervention, when to refer, impacted canines, clear aligners: to name a few!
• If a treatment outcome is not what you had hoped for, or if treatment progress is not “on track”, it is important to communicate directly with the referring dentist. Here a phone conversation is preferable, and an email second best!
• Take time to explain to your referring dentist the rationale behind your preferred retention regime. This also helps them when the patient arrives for their dentist recall visit with questions.
There are surely many more tips but one final point I’d like to make, referrers can wax and wane: don’t stress!
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“The
great enemy of communication, we find, is the illusion of it.”
William H Whytexcellent communication with your patients and their families is essential for a happy patient and a happy orthodontist. The evidence shows that most patient complaints are not because of a treatment-related error but because there was a misunderstanding or some other breakdown in communication between the orthodontist and patient. As you find your feet as a newly qualified orthodontist in a new setting with new patients, it can be easy to forget to tailor your communication to the patient in front of you. Remembering the following might reduce some of the potential obstacles to effective communication.
• Being empathetic, enquiring how patients are going and listening to patients creates an environment for effective communication. There is evidence, for example, to show that patients want to be asked about how they feel about being in the orthodontist’s clinic.
• It is import ant to realise that communication is not just verbal (spoken or even sung), you can
also use written (letters, patient information leaflets) and digital information to supplement communication.
• Ensure that the paralanguage (the tone and pace of how you speak) you use and the nonverbal communication (body language) you display is appropriate to the person you are communicating with.
• Your patients are not orthodontists! They will not understand our jargon. Keep words and ideas at a level that they understand. And this means you need to get to know your patient.
• It is often useful to ask your patient to ‘recap’. This means that you ask your patient to repeat any information imparted to them so that they understand the information in the way you intended. This is very important when patients are confronted with information about the risks, benefits and alternatives to treatment.
• You may need more than one appointment to communicate effectively with some patients especially if it is multidisciplinary or there is uncertainty before starting treatment. And that is ok.
• Always remember that you can reach out to work colleagues, mentors and the ASO for advice in navigating those difficult communication situations.
– NOW AVAILABLE
• What is consent, and how do I know if I have it?
- Dr Annalene Weston
• St anley Wilkinson Oration - Dr James Muecke AM
• Aligner Biomechanics: how to talk to the teeth so they will listen – Dr Willy Dayan
• Aesthetics, skeletal malocclusion and 3D technology. Have our clinics changed?Dr Juan Carlos Perez Varlea
• Virtually planned and direct 3D metallic printed orthodontic appliances – Simon Graf
• Class II treatment – Special goals for special patients – Julia von Bremen
PleaselogintotheASOMemberwebsitetoviewtherecordings.
