I recently attended a section 63 course run by the Yorkshire Deanery titled Medico-legal update, given by a medico-legal advisor who worked for Dental Protection. Inevitably the topic moved onto complaints; I was amazed by the detail of one particular claim, where a dentist had seen a patient as an emergency on the NHS, on a Saturday. The patient was complaining of pain and requested that the tooth in question was removed. The extraction proved difficult and a root was displaced into the antrum.
The dentist seemed to do everything right regarding follow up and appropriate referral. However, there were failings in his notes, which meant the case could not be defended, and the case was settled for close to £30k.
I didn’t think I would have done much differently from a clinical point of view to my unfortunate colleague, but was left reflecting how much detail (and time) I need to put into recording my notes to cover all eventualities.
Is it inevitable that some patients will complain? Almost certainly at some point you will receive a complaint; possibly with genuine reason, and possibly because they have seen a no win no fee advert.
I have actually heard one of these on a radio in a dental surgery!
The day before I attended the course I was carrying out endodontic treatment on an upper second premolar with sclerosed canals. I had found the buccal canal and after some time I thought I had found the very narrow palatal canal.
However, I soon realised this was not the palatal canal but I had in fact perforated the tooth and it was now unrestorable.
I told the patient what had happened, and apologised. The patient requested that I removed the tooth, and this was done without incident.
I went through my post-operative instruction and again apologised to the patient. The patient told me not to worry, and repeated that I had told him it was a difficult procedure, and that I had given him the option of going to see a root-filling specialist.
He added he was sure I had done my very best to do the treatment well, and it was just one of those things. He also wanted to know how soon he could pay to have an implant to replace the tooth, and also get one to replace his other missing tooth.
Certainly perforating an upper premolar was not my greatest achievement, but why was my patient so understanding and wanting to spend money on further treatment at the practice, and not wanting to make a complaint and take legal advice, like the patient mentioned earlier.
Maybe I was lucky, or maybe my patient is a nice person. It is in fact the latter. I also know that unfortunately one of his parents recently passed away following a long illness, and he looks after a disabled sibling. I also know his occupation, and what he likes to do in his spare time. I know how many children he has, their names, how old they are, and what stage of their education they are at. I am not a memory magician; in fact I get more forgetful as I get older. I have techniques to help me recall this information.
Why did the other patient referred to earlier complain? As I mentioned I don’t think the dentist had done too much wrong clinically, and had dealt with the complication appropriately.
Perhaps, it was not the first time he felt unhappy at the practice. Was the receptionist abrupt, is his dentist always late, had his previous 2 visits been cancelled, had he arrived 5 minutes late for his last visit and been told he couldn’t be seen, does he always feel his appointments are rushed, and he is not listened to.
I have no idea of the individual’s history, but I know people are more likely to complain if there is a series of annoying events rather than an individual incident.
Thinking about my patients I do seem to have a lot of nice patients. Why is this? My practice is not in a particularly affluent area, but we seem to attract nice patients, who have a desire to receive high quality dental care that they are prepared to pay privately for. It is probably because I invest time in my patients to find out about them, and build up rapport.
My staff have been trained to act in a similar way, so often I know a lot about a new patient before I even see them.
Everything we do is to create an environment where our patients are impressed, and feel that they are VIP patients. They then tell people about the great experience they have had.
Those people then wonder why they don’t get the same experience at their dentist, and lo and behold they contact us.
Nice people know nice people. The other great benefit of having nice, happy patients is that if something doesn’t go to plan clinically, our patients are much more understanding because they feel valued and trust us, and want to look for a clinical solution rather than making a complaint.
This time spent building relationships with our patients means we avoid complaints, and this is obviously a much better situation to be in.
We don’t allow ourselves to rest on our laurels though. Complacency will allow standards to drop, and a bad patient experience will unfortunately travel faster than a good one.
We do still unfortunately get complaints, but thankfully the frequency is very low, and often it is because we ask for feedback, good or bad.
Sometimes we do drop the ball, and we let our patients down by not meeting our own high standards.
When we investigate the issues raised by a complaint, we often identify areas we could have done better in, and feed this back to the complainant. This is often a great learning experience for our team, and ensures we get it right moving forwards.
We also often find that if we deal with the complaint well, the complainant becomes an advocate for the practice and spreads the word about how we helped them.
The take home message from my course was that it was much better to avoid a complaint in the first place, than to have to deal with one.
If you do have to deal with a complaint, give it the time and importance it deserves. Inevitably, dealing with complaints takes time, and can be very stressful especially if the GDC become involved.
Your indemnity company will always be there to help if you are unfortunate enough to receive a complaint, and it is always best to contact them for advice as soon as possible.
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