The study of ‘human factors’ involves understanding that errors do not happen by accident. Rather, it is the appreciation that a multitude of factors have contributed to that particular outcome. It is imperative that our profession acknowledges and recognizes the role of human factors in our daily practice, and that we use this understanding of human factors to support clinicians when inevitable adverse incidents occur in our careers.
During undergraduate dental school, a great deal of the curriculum focuses on fundamental oral conditions, such as plaque-related diseases, and the management of these conditions. However, the concept of ‘human factors in dentistry’ is also a core topic of relevance, that in the author's opinion is not always given the necessary importance, both at an undergraduate and a postgraduate training level.
Dental Protection and the Medical Protection Society both report that 80% of litigation from patients is due to human factors. Yet, many dentists are not even aware of what this term is, let alone what it means. How can dentists reduce the risk of errors if there is a lack of awareness of this issue in the first instance? As an undergraduate dental student, open discussion about ‘clinical errors’ or ‘mistakes’ that are likely to occur once dentists become qualified are seldom discussed. During the author's training, the topic of human factors in dentistry was not taught as an undergraduate lecture or a workshop seminar in any capacity. The premise that a qualified dentist could make the unfortunate mistake of extracting the wrong tooth, separate an endodontic file during root canal treatment or cause a lip laceration during a crown preparation would be inconceivable to both the general public, as well as most unqualified dentists. However, it would be naïve among our profession to believe that a BDS degree comes with a ‘no-mistakes’ insurance clause. Unfortunately, in all aspects of healthcare, mistakes are very much a part of the profession. In hospital medicine, monthly debrief meetings are held to openly discuss mistakes in ‘morbidity and mortality meetings’ to allow clinicians the opportunity to improve outcomes and reduce errors. Historically, the field of dentistry has not adopted the same attitudes towards mistakes as the medical profession. Thus far, our profession has failed to regard the learning opportunities, with open discussion of mistakes, with the same level of importance, and often our errors are kept quiet for fear of reprimand from our healthcare regulators, such as the General Dental Council, as well as from our colleagues and patients. That is not to say that clinical incompetence in dentistry is something that should be accepted or condoned in any way. What should be addressed is how mistakes are handled within dentistry, both individually, and as a profession. Instead of blame and shame, mistakes should be openly discussed among colleagues so that lessons can be learned, not only from what happened, but, more importantly, to understand why it happened so that it can be prevented from happening again. This learning process should be of greater importance than the previous rationale within the NHS of blaming and fault finding of the clinician. The focus should be driven towards raising awareness of one's own behaviours and interactions with others within the working environment for the benefit of patients, the team and the clinician's own personal wellbeing. However, until the stigma of clinical mistakes in dentistry being equated to clinical incompetence is stopped, the profession will continue with the fallacy that we are acting in our patient's best interests by hiding our mistakes.
