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DISPATCH Vol. 27, No.1 February/March 2013Dispatch is the official publication of the Royal College of Dental Surgeons of Ontario (RCDSO). RCDSO is the regulatory body governing the practice of dentistry in Ontario. Dispatch is published four times a year. The subscription rate is included in the annual membership fee. The editor welcomes comments and suggestions from our readers.

MANAGING EDITOR Peggi Mace

SENIOR EDITOR Angelo Avecillas

ART DIRECTION AND PRODUCTION Roger Murray and Associates Incorporated

COVER DESIGN Steve Adams and Public Good Social Marketing Communications

REGISTRAR Irwin Fefergrad, CS, BA, BCL, LLB(Certified as a Specialist by the Law Society of Upper Canada in CIVIL LITIGATION and in HEALTH LAW)

Reprint Permission

Material published in Dispatch should not be reproduced in whole or in part in any form or byany means without written permission of the College. Please contact the editor for permission.

Environmental Stewardship

This magazine is printed on paper certified by the international Forest Stewardship Council ascontaining 25% post-consumer waste to minimize our environmental footprint. In making thepaper, oxygen instead of chlorine was used to bleach the paper. Up to 85% of the paper is madeof hardwood sawdust from wood-product manufacturers. The inks used are 100% vegetable-based.

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ISSN #1496-2799

FRONT & BACK

4 The Presidents MessageTransparency and opennessfundamental to putting patients first

48 From the RegistrarPerformance review ofprofession-led self-regulation

DEPARTMENTS

Malpractice Matters23 Minor change to the PLP

deductible formula

24 What Price Perfection? The personal and professionalcosts of being too hard on yourself

Professional Practice32 Sedation & Anesthesia Advisory:

Recovery protocol and patient scheduling

34 Can dentists provide smokingcessation programs for patients?

37 Prescribing primer

Practice Bites40 Take care to properly obtain and

document informed consent

42 PEAKContinued competencyassessment in dentistry

44 College Mailbag

45 Calendar of Events

ISSUE ENCLOSURES

Discipline Summaries

PEAK: Continued Competency Assessment: Its history and role in the health professions

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PRESIDENTDr. Peter Trainor

VICE PRESIDENTDr. John Kalbfleisch

Dr. Robert CarrollDr. David Clark Dr. Lawrence Davidge Dr. Sven GrailDr. John Kalbfleisch Dr. Lisa Mary Kelly Dr. Elizabeth MacSween Dr. David SegalDr. Joe StaskoDr. Peter TrainorDr. Flavio Turchet Dr. Ron Yarascavitch

Royal College of Dental Surgeons of Ontario6 Crescent Road, Toronto ON M4W 1T1

416-961-65551-800-565-4591fax: 416-961-5814info@rcdso.orgwww.rcdso.org

RCDSO COUNCIL MEMBERS

APPOINTED BY LIEUTENANT-GOVERNOR IN COUNCIL

Kelly Bolduc-OHare Little CurrentTed Callaghan SudburyBeth Deazeley OakvilleKurisummoottil Joseph Thunder Bay Manohar Kanagamany MarkhamCatherine Kerr StevensvilleEvelyn Laraya Toronto Dr. Edelgard Mahant TorontoMarianne Park WoodstockJose Saavedra WoodbridgeAbdul Wahid Scarborough

ACADEMIC APPOINTMENTS

Dr. David Mock University of TorontoDr. Richard Bohay Western University

6 Youth and prescription painkillers:What parents need to know

8 Who made that dental floss?9 Elections 2013-201516 Provincial advertising regulations

still applicable today19 Your Online e-Portfolio: Track your CE footprints26 Report from Wellness Conference30 Successful launch of QA Programs

Practice Enhancement Tool 38 Understanding the reality of mental illness

Part one of a four part series

TThe rise of social media and unprecedented public access to real timeinformation has had repercussions around the globe raising publicexpectations of transparency in government. Ontario Ombudsman Andr Marin made that statement in June 2011 aspart of his call for the provincial government to embrace the worldwidetrend toward open government.

Those words resonate even more today. This is the age of accountabilityand transparency. The publics expectations are high. It should then not besurprising that the media and the public are asking pointed questions abouthow health care colleges work and why more information about registrantsis not made public.

In January this year, a series of articles in the Toronto Star, the nationslargest daily newspaper, focused on cautions. A Star investigationtabulated that more than 2,200 cautions were issued to Ontario health-care professionals between 2007 and 2011 by the colleges that regulatethem. None were ever made public. The Star found that these cautionsoften dealt with serious issues, such as improper communication withpatients, a lack of timely referrals and errors in prescribing medication.

Due to the media storm created, the Minister of Health was forced torespond publicly, giving colleges the go-ahead to publicize cautions. Sheurged colleges to continue to review their policies to support our sharedgoals of transparency and responsibility to the public. Both theConservative and the NDP health critics joined in calling for the healthminister to make sure that the public gets the information it needs to makeinformed decisions about their care and are protected.

Our College will be undertaking that review over the coming months.

We already have a long-time commitment to transparency in the processeshere at the College: reprimands are done in the open as part of the

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THE PRESIDENTS MESSAGE

Transparency andopennessfundamental toputting patients first

PETER TRAINOR

THE PRESIDENTS MESSAGE

discipline process; all terms, conditions andlimitations on a dentists licence are posted on ourwebsite; notices of hearings and all disciplinarydecisions are made public and available online fromour website too.

However, there continue to be vast changes in theinformation landscape. The public is paying veryclose attention to how transparent government andgovernment agencies are as a part of makingassessments about how well they are doing their job.Transparency and accountability do matter.

In early February, a 1,700 page report was publiclyreleased in London, England that is bound to haveramifications in every country with a public healthcare system. The two-year study looked at oneparticular hospital in England where as many as1,200 people died unnecessarily between 2005 and2009. The release of the report led to a publicapology by the British Prime Minister in the House ofCommons and a commitment to review and act onthe reports nearly 300 recommendations.

As the author of the report, Robert Francis, said inhis press statement, people were failed by a systemwhich ignored the warning signs and put corporateself interest and cost control ahead of patients andtheir safety. He found an institutional culture inwhich the business of the system was put ahead ofthe priority that should have been given to theprotection of patients and the maintenance of thepublic trust . Transparency and openness werereplaced by deliberate obstructions of the truth.

The report found a health care system that had lostits way. A system that no longer put the patient first,where standards and methods of measuringcompliance did not focus on the effect on patients,and where there was too great a degree of toleranceof poor standards and of risk to patients.

It is a reminder that as a regulator we can never becomplacent. We can never avoid challenges byresorting to taking the easy way out. We need tocontinue to be a model of openness andtransparency. We need to constantly refocus andrecommit to putting the patient first.

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Pour mettre le patientau premier plan, ilfaut avant tout de latransparence et delouverture

Suite la page 46

L La monte des mdias sociaux et laccs sansprcdent du public des renseignements en tempsrel a partout au monde leffet de rehausser lesattentes du public envers la transparence desgouvernements. Lombudsman de lOntario Andr Marin avait faitcette dclaration en juin 2011 dans le cadre de sademande au gouvernement provincial dadhrer latendance mondiale vers un gouvernement ouvert.

Ces paroles sont encore plus pertinentes aujourdhui.Nous sommes lre de la responsabilisation et de latransparence. Les attentes du public sont leves. Ilnest donc pas surprenant que les mdias et le publicposent des questions pointues sur la faon dontfonctionnent les organismes de rglementation dessoins de sant et sur les raisons pour lesquelles lesrenseignements sur leurs membres ne sont pas renduspublics.

En janvier de cette anne, une srie darticles duToronto Star, plus grand quotidien au pays, sestpenche sur les avertissements. Une enqute du Star arvl que les organismes de rglementation desprofessionnels des soins de sant ontariens leur ontsignifi plus de 2 200 avertissements entre 2007 et2011. Aucun dentre eux na t rendu public. Le Stara dcouvert que ces avertissements avaient souventtrait des questions graves, notamment lacommunication inadquate avec les patients, le dfautdadresser en temps voulu et des erreurs danslordonnance des mdicaments.

This reader-friendly brochure was

created by the Centre for Addiction and

Mental Health to provide