With the number of complaints about unsatisfactory treatment on the rise post-COVID-19, Angela Love discusses some of the common themes and offers risk management advice.
Unhappiness with the outcome of dental treatment has always represented a high proportion of the Dental Defence Union’s (DDU) complaints files. Such complaints might previously be thought to be due to human error. However, the pandemic has demonstrated that things are seldom so clear cut.
There are often multiple factors that contribute to an unsuccessful outcome. For example the patient’s general oral health and their ability to follow dental advice. Also, whether they have realistic expectations of what we can achieve.
During the pandemic treatment plans were put on hold, which heightened the risk. It was harder to maintain patients’ oral health, which increased the chance of a poor outcome.
Analysis of complaints files opened by the DDU between 15 March and 1 December 2020 showed that ‘unsatisfactory treatment’ accounted for 40% of cases.
The number of complaints was relatively low during this period because of the pause in routine treatment. Although, we have started to see an increase in such complaints and we think this trend will continue in the coming months.
- Patients who were unhappy about the interruption in their treatment and suspension of dental services
- Problems with orthodontic treatment plans, especially where some relapse occurred due to breakages of the appliance used. These complications and delays understandably frustrated patients
- Patients who believed that they had received unsatisfactory treatment before the pandemic and were unable to have their concerns addressed because of the pandemic
- Concerns about emergency treatment, such as extractions. This includes patients who were unhappy that it wasn’t possible to have root canal treatment to save the tooth.
Tips and advice
It is impossible to completely rule out the possibility of unexpected technical problems during treatment. However, the following tips should help you reduce the risk and manage patient expectations:
- Be sure you are trained and sufficiently experienced to carry out a procedure. Assess the situation. Bear in mind the potential complications and the degree of difficulty in providing that treatment for the individual patient. If you are unfamiliar with a treatment, seek advice. Be prepared to refer the patient if this is clinically indicated
- Always be realistic about the prospects of treatment. You should be up front about the risks
- Make detailed notes about the patient’s priorities and concerns about treatment. You can address these during the initial consultation and throughout treatment. Especially if circumstances change
- Discuss the possible complications of treatment with the patient as part of the consent discussion. Ensure they are aware of all the treatment options, including no treatment. For consent to be informed and valid, you must cover the recognised complications and the risks that the patient is likely to consider significant
- Provide clear information on what patients should do if there is an emergency. For example, an appliance breaks, they are in pain or have a suspected infection
- Ensure the practice has a system in place to triage emergencies. Also, that the website/answerphone system explains how patients can access urgent care outside usual practice hours
- If something goes wrong during a procedure, tell the patient immediately. Apologise and explain what you propose to do to manage the situation
- It is a good idea to check the progress of long-term treatment at regular intervals. Be prepared to reassess your treatment plan with the patient’s consent. An amended plan should be issued in writing and include a cost estimate.
The following fictitious scenario, based on DDU COVID case files, illustrates a typical complaint.
A man in his sixties had been fitted with a partial denture a few months earlier but a clasp broke while he was eating. The patient had made an appointment at the practice so his denture could be fixed but dental services were suspended before this could happen.
The patient left repeated messages with the practice over the next few weeks, complaining that the denture broke due to poor quality. He then wrote a letter, demanding that the practice investigate the laboratory that made his denture and refund the cost. He complained that the denture was too loose to wear but he could not leave the house at all with missing teeth.
The practice complaints manager investigated and discovered that no one had responded to the patient’s telephone messages due to a breakdown in communication at the practice.
She wrote to the patient apologising for the delay in addressing his concerns, explaining what had gone wrong and how the practice planned to ensure an error like this did not happen in future.
As a goodwill gesture, the practice agreed to refund half the cost of the treatment and repair the denture at no extra cost.
By this point practices were able to resume treatment and she was able to offer the patient an early appointment to fix the problem.
The patient welcomed the practice’s constructive response and the complaint was resolved.
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This article was first commissioned for Dentistry magazine. Read the latest issue here.
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