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.
As dental practitioners we are very aware of our obligations to communicate effectively and assist our patients where possible with their concerns and complaints, especially if things go wrong in practice. But what if we are unaware of the issue? Can a poorly thought through comment from our frontline staff, or lack of insight or poor training on how to handle patient complaints, tip the scales towards complaints being more likely to occur?
Case study
Miss K was a young patient with a hypoplastic dentition, putting her in a high-risk category. Unfortunately, at one of Miss K’s regular examination appointments a moderate size interproximal lesion was not identified, with the tooth experiencing breakdown only two weeks after her check-up.
Miss K’s mother was in contact with the practice to arrange another appointment to have this tooth addressed. At this time, Miss K’s mother spoke with one of the receptionists voicing her concern about seeing the same practitioner again and indicating a preference to seeing a more experienced practitioner. The receptionist had viewed the bitewing provided by the mother and commented “The hole is pretty large – the only issue is that the only appointment I have available is in six months. What if she gets a toothache before then?”
Understandably Miss K’s mother also thought this was a very big issue and being somewhat heightened, was not appreciative of what she interpreted as an insinuation that she was setting her daughter up for toothache unnecessarily, especially seeing as she had brought her for a check-up only weeks prior.
Being somewhat offended by the front office staff and annoyed that they seemed unwilling to help, Mrs K proceeded to make an appointment with another dental practice with her concerns. Unfortunately, during this appointment, a number of issues were identified with some restorative treatment that had been provided recently, as well as additional missed caries further to the tooth they were already aware of, which had now continued to progress to the point of requiring nerve treatment.
The Tipping Point
The lack of responsiveness and responsibility from the practice primed this parent to complain, however the Tipping Point did not arise until further issues were identified. The parent made a formal complaint to the practice.
Discussion
Complaints can be a difficult area to work in and can cause much anxiety both for the person complaining, the practitioner, as well as the front office staff members assisting.
It can be helpful however to reframe the process, to consider that as practitioners, we in fact do, or should, want to know about our patients’ complaints or concerns. Without patients bringing these to us directly, we are unable to assist them, and I am sure there are many of you who would be deeply troubled to think there were patients out there who had legitimate issues with the treatment we provided, that we could have helped with, but they felt that they could not come to us and had to rectify them alone.
We work in close-knit teams, and we rely on the assistance from our front office staff to assist in this process. It can become difficult in instances where we are not made aware of issues that have been raised, or if they have not been handled effectively when first presented.
Outcome
In this particular case Miss K’s family had developed a relationship with the practice, and they had returned to them with the expectation that the missed caries would be addressed in a timely manner. Unfortunately, Mrs K felt that her concerns had been dismissed by the staff member at the first point of call who was there to assist her, and consequently sought advice from another practice.
This left the practitioner in a vulnerable position, firstly in the missed diagnosis, as well as opening them to further criticism in other areas of their treatment. Had the practice had a system in place for addressing the concerns in a timely manner, it would have enabled them to rectify the issue, keeping their patient, and further cementing the bond and goodwill that had been established throughout their relationship.
Mrs K wrote a letter setting out her concerns, and the understandably distraught practitioner sought the assistance of Dental Protection in writing a response, apologising for the error and the poor management of Miss K’s issues when identified, and offering to cover the costs incurred for retreatment. Mrs K accepted this but did not return to the practice.
Learning points
We are all human, and things can go wrong in the practice of dentistry. If this does happen, it is fair and reasonable that steps are taken to assist patients to rectify the situation where possible.
All staff within the practice play an important role in the complaints process, so that issues can be dealt with effectively in a timely manner, to prevent unnecessary escalation.
It is prudent for each practice to have a complaints policy to manage patient complaints, and that all staff are trained in how the process should proceed.
Dental Protection has resources available in this area including podcasts and dentolegal articles, as well as the comprehensive Handling Complaints (Australia) booklet.