I've just seen a patient for a check-up who is usually seen by one of my practice associates. I'm concerned because she has caries in several teeth which have been marked as 'watch' in the records and the radiographs also show lesions. I have advised the patient to make an appointment with my colleague but I don't want to undermine him, and so I've not yet told the patient about my findings. What's my next move?

The first job is to speak to you colleague about your findings and treatment recommendations. Talking to him in the first instance may give you an opportunity to discuss his approach and rationale. After all, he has more experience with this particular patient and may be able to tell you about her wishes and priorities which put his actions in context. Even if he allays your fears, it's still a good idea to put things in writing as well.

If the response to your approach is not positive and you're concerned about the patient's overall care, you would be justified in advising the patient directly. It would be advisable to warn your colleague of this in advance.

When talking to the patient, avoid direct criticism of your colleague. While you may have concerns about her treatment, you're not in a position to pass comment or judge whether he is competent to practise. Other explanations could exist for the patient's oral health problems - she may have refused to accept his oral health advice. If the patient wants to make a complaint, you can explain your practice complaints procedure.

If you believe that the dentist's actions raise serious questions about his treatment of other patients, you will need to consider what to do next. Even if you are understandably reluctant to report a fellow professional, the GDC makes it clear that 'the duty to raise concerns overrides any personal and professional loyalties'.

If possible, you should first raise your concerns with your employer or manager, following your practice's procedures. If you can't, consider approaching someone from the Local Dental Committee (LDC). If you need to escalate matters you can consider raising your concerns with the Local Area Team or local Health Board. The most serious concerns might need to be reported to the Care Quality Commission or its equivalent, or even the GDC. However, in circumstances like this it's likely that the concerns can be addressed at a local level without the need to escalate them. Make sure you keep a record of your concerns and the steps you've taken.

Q&As - a snapshot of your ethical dilemmas

Q&As - a snapshot of your ethical dilemmas