Patient safety is one of the key focus areas of FDI and FDI Councillor Prof NerminYamalik, who has written and lectured extensively on the subject. She participates in a number of FDI committees and task teams that have either direct or indirect impact on the issue, notably the FDI World Oral Health Workforce Task Team. She notes that a number of FDI activities address patient safety either directly or indirectly. "However, a specific statement on patient safety or even a charter of patient rights is missing and I feel that we need to work in this direction," says Prof Yamalik. Outside FDI, Prof Yamalik works on patient-safety related issues with a number of international and European partners. She maintains permanent liaison with the World Health Organization and was FDI expert on the WHO Expert Working Group that developed the 'Mulitprofessional Patient Safety Curriculum Guide for Health Professions'. "I feel that it is one of the best resources in its field and I am very proud to be a part of it," says Prof Yamalik. Prof Yamalik, what are the essential differences between patient safety within the field of dental medicine and within the field of medicine in general? Although dentistry always has a genuine concern for patient safety, the first thing I can say is patient safety is quite 'immature' in dentistry when compared to medicine. There are several reasons for this. Firstly, in medical practice, they started earlier due to the serious consequences of 'errors'. Dental errors may be perceived as 'less' serious. Secondly, health care is mostly provided on an institutional basis (e.g. in hospitals), while dentists are usually solo-practicing professionals and are a little 'isolated'. Reporting of incidents may be quite low. It is different to implement patient safety measures in institutions compared to dental practices. Thirdly, medical care is generally provided by teams of professionals and this team approach is quite different from team work in dentistry. The way patients perceive dentistry and medicine may also differ and this may act as another determinant. What are the main areas of concern? We carried out a patient safety/risk management survey among the FDI member national dental associations: it clearly showed us that in most countries there is not much information available and some countries lack particular laws and regulations about patient safety. Naturally, it is important to have the necessary laws and regulations; however, the attitude of dental practitioners (e.g. reluctance) also seems to be very important. It is essential that dental professionals do not see implementation of quality care, standards and patient safety measures into daily dental practice as a bureaucratic process. Improving the working conditions of dental professionals and the dental team and supporting them in complying with the patient safety measures is also an important factor. The impact of culture and the disclosure of errors and 'apology' is another topic of discussion. The pressure that a health professional may feel when a 'culture of blame' is operating is also an issue of concern. Is there any important issue within the field of patient safety that you feel is not being addressed or is being inadequately addressed at this time? The multifactoral nature of patient safety and the many determinants are likely to be either underestimated or to a certain extent ignored. The particular difficulties of health professionals in complying 100% with patient safety measures (e.g. shortage of health professionals, limited infrastructure, etc.) also needs to be addressed further. What patient safety standards does Turkey currently implement and how is patient safety currently regulated? Last April a new regulation was introduced, which was developed by the Ministry of Health. Although there have always been lectures dealing with some patient safety issues under the heading of 'ethics', patient safety is recently being treated as a relatively new (separate) discipline in most of the medical and dental faculties. In most faculties we notice topics of patient safety in the medical and dental curriculum. We also see more continuing education courses. In practice, what disparities exist between implementation of patient safety rules in urban and rural practice? As expected, there are clear discrepancies. However, it is not only a matter of geographical location. Even in urban settings we may see that patient safety is either underestimated or lacks the desired priority in general. So it is my personal feeling that the problem in implementation of patient safety measures to daily practice is deeper than we may assume. What is the biggest risk a patient faces and how is this managed under current procedures? Although most dental procedures are carried out without significant negative outcomes, it is obvious that every intervention has some risks. Complying with the patient safety measures, trying to reduce errors, provision of quality care and maintaining updated professional standards, etc. are all essential. We have to realize that the general measures to reduce errors and increase patient safety are not so different from what common sense tells us. As an example, when we are tired, errors may increase. So we need to keep this in mind when programming our daily work schedule. Having a good dentist-patient relationship, respecting patient rights, having informed consent, continuing education, having concern for the quality of dental equipment and materials/products, etc. also deserve a particular interest. All these once again highlight the fact that when patient safety is concerned, it's the multifactoral nature that needs to be considered. Note: The opinions expressed in this interview are Prof. Yamalik's own: they do not necessarily reflect the views of FDI.
