Raise your hand if you've ever had an unsatisfied patient. My guess is that everyone's got their hand up. If you haven't, unfortunately it will happen at some point.
While we as dentists are there to provide a healthcare service, our patients are still customers. On the whole, most are content with the treatment they receive; but rare occasions do arise when they aren't. Patients are far more inclined to talk about a bad experience than a good one. If complaints are nipped in the bud, you've evaded damaging both yours and your practices reputation.
Dentistry is a very personal healthcare requirement. It really is the invasion of someone's personal space requiring the examination and management of what many consider to be an intimate area. You may know your friends and family very well, but how many of their mouths do you look into on a regular basis? We're now in an ever more litigious society where the public are encouraged to pursue their rights. Patient expectations are growing and even the slightest error can be costly. With GDC cases on the rise, it's best to avoid being banded in that statistic.
Therefore, it's no wonder the GDC recommends that dentists and DCP's keep up to date by undertaking CPD in legal and ethical issues and complaints handling. In addition, Principle five of the Standards for the Dental Team states that there should be a "clear and effective complaints procedure". The aim of this article isn't to scare you and far from it; it's to present how much support is available and minimise and mitigate complaints as much as possible.
Playing dodgems
Good communication is a fundamental cornerstone of modern dental practice. Empathy, sympathy and understanding are all useful ways to relate to your patient. There's a well know phrase in healthcare that patients don't sue friends. Of course, this isn't always true and should never be taken for granted. However, history and experience does show that patients we like and respect are less likely to have any significant grievances towards you in the event of untoward situations.
If it's not written in the notes, it didn't happen. Meticulous and contemporaneous record keeping is essential. As always, notes should be thorough and record all findings, special investigations, diagnoses, conversations and discussions, estimated treatment costs, treatment planning, detailed descriptions of the treatment provided and warnings and potential sequelae of treatment outcomes should the initial treatment be unsuccessful. Excellent dental records are always the leading defence in refuting any claims made against you.
Know your limits. If it's not within your remits, having a go and seeing how things turn out is not the right way to go about it. Never be afraid to refer your patient to a more experienced dentist or specialist. Doing the right thing for the patient is always the top priority. Taking on work that is beyond your scope of practice can open you up to a myriad of troubles, because when it fails, it tends to fail spectacularly. Avert disaster by not biting off more than you can chew.
Saying sorry is not an admission of guilt. It's such a simple word that's used every day with a plethora of meanings. Just because you've said it, doesn't mean you did anything wrong. Often, it's the key word that your patient wants to hear and that can be enough to make them feel better. For a simple word, it can be extremely powerful.
All these topics have been discussed in more detail in previous articles which can all be found on theyoungdentist.com. There's also a heap of information and CPD to be found in the Risk Management section on the Dental Protection website.
Is it a bird...is it a (paper) plane...?
There are several types of complaint, ranging from a simple inference to a GDC case review. Whichever way you look at it, they're all complaints, no matter what their severity.
Most verbal complaints tend to be made directly to staff in the practice, whether clinical or not. All staff should try to appease the situation and halt its escalation. If the patient is still dissatisfied with this outcome, this tends to result in a written complaint to the practice. On occasion, this may be the initial route of complaint and can sometimes be surprising as there may not have been any indication or inclination that the patient was intent on lodging a complaint at all.
In many instances, these can be resolved by having open and honest discussions between the patient, the original dentist, the practice manager, the principal dentist, the practice owner or any combination of these persons. This highlights the importance of accomplished communication skills and exemplary record keeping. At least this way, things can be dealt with in-house, possibly even with some informality. Nevertheless, they should still be approached with due care and handled with gravity.
Complaints from patients can also be made towards a dentist and practice indirectly through third parties who can be anyone from the Local Area Network team to solicitors acting on the instruction of a patient to the GDC. Due to the formal approach of the complaint and the involvement of third parties, these should be responded to in more formal tones also.
DPL's spectrum of Communication Skills Workshops can provide you with valuable tools in diffusing these situations. Studies have indicated that up to 70% of litigation is related to poor communication. The easiest way to counsel any complaint is to limit one happening in the first place and the workshops help in reducing your exposure to the risk. As an added bonus, they're even free of charge to DPL members and worth three hours of verifiable CPD.
The written rule
As stated, all practices must have a complaints policy. Not only is this a requirement of the GDC and CQC to ensure patients' rights are protected, but this also assists the practice to move swiftly if a complaint is made. In the deplorable circumstance of the complaint, a clear policy will aid staff to keep a level head and take the correct steps; as well as providing guidance on how the matter will be dealt with and participation needed in which role to partake in in its resolution.
On first receipt of the complaint, the practice MUST acknowledge the complaint within three working days of the date it was received. Also within this period, an offer MUST be made to discuss the management of the complaint with the patient and the expected timeframes for its investigation and response.
The practice is then obliged to investigate the complaint and keep the complainant informed about its progress. The investigation may include:
- interviewing staff
- speaking to the complainant
- examining the patient records
- arranging second opinions (internal or external)
- a review of processes and procedures
- identifying improvements
Finally, a written response signed by the RESPONSIBLE PERSON must be sent to the complainant containing:
- a report of the investigation and its conclusions
- any taken or planned actions
- the complainants right to appeal to the Ombudsman
As always, one of DPL's 50 dento-legal advisers is always on hand to support you at your time of need. They are a multi-faceted team with a wealth of nous, skills and experience who have been in this position on many occasions. While the scarce (thankfully!) situation of a complaint may be alien to you, it's certainly not to them.
Moving on
Dentistry is all about personal relationships. Just as you may have patients that you dislike seeing, there will be patients who would prefer not to see you. You can't please every single patient 100% of the time. Just because your patient might have chosen to change dentist, it doesn't mean they don't like you as a person. It takes some time to develop a thick skin and not take those patient actions to heart. In time you'll soon realise the patients reasoning and don't forget that this could also prevent a prospective complaint from occurring against you.
One of the most disappointing things about a complaint can be that the dentist hasn't learnt anything from it. Take a good look at yourself to evaluate any flaws and weaknesses. This way, you know you've gained from the experience. It will make you more confident in your approaches to similar situations by appreciating you've benefited and become a stronger dentist. It's crucial to turn a negative episode on its head into a positive outcome and you'll feel happier from it.
As with any complaint, no matter how big or small, it's hard to shrug it off. Many dentists will continue to carry their complaints on their shoulders throughout their careers. But that's what benefits those dentists progress and bypasses future hazards. It's hard to find the right balance of taking a complaint seriously and dwelling on it, and being blasé about it. Certainly, err on the side of caution and take it more seriously; take some time to reflect on things. Only then can you process what happened. More importantly, you can feel assured in stepping back into the surgery as an improved dentist; with greater purpose and wisdom than the day before.
Hussein Hassanali
Dental Protection provides a whole range of risk management to support you through your career.
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