There is a moment in every case where a disgruntled patient becomes a complainant. The Tipping Point is a series of cases and commentary which highlight that very moment.
Assuming patients know or understand the importance or reasoning behind a course of treatment can get you into hot water when a complaint is made.
Case study
Dr A consulted with a patient whose primary concern was the appearance of her six upper anterior teeth, which exhibited erosion, chipping and staining. After a full discussion of available options, their respective advantages and disadvantages and costs, the patient agreed to proceed with composite resin veneers from 13 to 23.
Dr A took scans/models and sent them to a laboratory for a diagnostic wax up of the proposed veneers. They showed these to the patient, transferred the proposed design to the mouth in a temporary resin, and obtained the patient’s approval to proceed. Dr A then provided the composite veneers as agreed, performing minimal tooth preparation as the veneers were primarily additive in nature to restore lost tooth structure, including incisal length.
Before and after photographs were taken and the patient, apart from some very minor alterations to the incisal length, appeared very happy with the final result. Dr A advised that, consistent with the original quote, a protective maxillary splint/nightguard needed to be worn. The patient did not return for its fabrication.
The dentist left the practice soon after this restorative treatment was completed.
The Tipping Point
A few months later, the patient returned with one of the incisal corners fractured on the 21. This was repaired at no charge by the principal dentist at the practice, due to the original dentist having moved on. An estimate was reissued for the splint. Sometime soon afterwards, the same corner fractured again. The principal advised the patient that a splint needed to be worn and in fact they had already been told this, so they just needed to get on with it.
Disgruntled at being told ‘I told you so’ and, with the fact that she felt Dr A had provided extensive treatment and taken her money, but was not there to help when she had problems, the patient sought retreatment elsewhere. This resulted in the placement of ten porcelain veneers, which quickly chipped.
The patient remained angry with Dr A as she perceived that they had ‘started the ball rolling’ and a formal complaint against them was made, seeking refund of all treatment costs paid.
Outcome
Dental Protection assisted Dr A with their response and, ultimately, the matter was dismissed.
Learning points
Case selection remains an important part of care – it is critical that patients who have treatment that requires maintenance or additional care are committed to all the treatment, not just the bits they want.
An opportunity to emphasise the importance of the splint was missed when the incisal corners were repaired. Reissuing the estimate without discussion did not highlight the relevance of this treatment.