The Colleague Who Is Always Running Late
You are the clinical lead at a three-dentist practice. Over the past four months, one associate has consistently run 30-45 minutes behind, has cancelled two full clinic days at short notice, and has had three patient complaints about rushed treatment and poor communication. Support staff have reported that he frequently leaves instruments unsterilized at the end of the day and has twice failed to complete medical history updates. He is well liked by patients and is a skilled clinician. The practice owner is his personal friend and has dismissed the concerns as "just his style." You have a practice meeting scheduled next week.
1. What are the professional, ethical, and legal issues, and how do you raise them?
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Professional and ethical issues:
- Patient safety and standard of care. Unsterilized instruments and incomplete medical histories are direct risks to patients. Infection control failures and inadequate medical history updates are not matters of personal style; they are breaches of accepted standards.
- Continuity and access. Repeated late-running and short-notice cancellations disrupt care and inconvenience patients.
- Communication and consent. Complaints about rushed treatment raise questions about whether informed consent and patient education are being adequately provided.
- Collegiality and whistleblowing. A clinician has a professional duty to act on concerns about a colleague's fitness to practise, and failing to do so can itself be a breach of professional obligations.
Legal issues:
- Infection control is typically governed by regulation and may be subject to inspection; failures can result in enforcement action and liability.
- Record keeping requirements mean incomplete medical histories are a documentation deficiency, not merely a clinical one.
- Employment law considerations apply: any action must follow the practice's policies and the associate's contract, and must be fair and documented.
How to raise them:
- Prepare evidence. Gather specific dates, incidents, complaint details, and staff reports. Avoid generalities.
- Speak to him privately first, in a non-punitive, solution-focused way. Use specific examples and ask open questions about workload, health, or other pressures.
- Escalate to the practice owner with evidence if the behaviour does not change, framing the issue around patient safety and practice risk rather than personality.
- Follow formal processes - performance improvement plan, review dates, and, if necessary, referral to the relevant regulatory body.
- Document every step.
The judgement tested is acting on a colleague's unsafe practice despite a friendship with the owner and the associate's popularity.
2. The practice owner tells you to "drop it" because the associate brings in a lot of revenue. What do you do?
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Response:
- Do not drop it. Patient safety obligations are not contingent on revenue. State clearly that the infection control and medical history issues are non-negotiable and that you cannot participate in ignoring them.
- Reframe the risk to the owner in business terms without making that the only argument: regulatory inspection, complaints, liability exposure, and reputational damage are all plausible consequences of inaction. A single infection control breach can close a practice.
- Separate the issues. The revenue contribution is relevant to how the practice manages the situation (for example, supporting the associate with scheduling changes or additional training) but not to whether the concerns are addressed.
- Escalate appropriately. If the owner continues to block action, consider your own professional obligations: document your concerns, and if necessary report to the relevant regulatory authority. In many jurisdictions, failing to report a colleague who poses a risk to patients is itself a professional breach.
- Protect yourself. Keep contemporaneous records of your reports and the responses, and seek advice from your professional association or indemnity provider.
- Consider the team. Support staff who raised concerns should not be penalized; ensure they are protected and that their reports are taken seriously.
Key point: Loyalty to a colleague or to the practice's finances never overrides the duty to protect patients. The exam is testing whether you can hold that line under pressure from an authority figure.