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When the time is right

05 September 2019

A hygienist member of Dental Protection contacted us to report that the practice she worked in had received a strongly worded telephone complaint concerning an initial calculus debridement she had provided

The patient, who had not had any oral hygiene treatments in eight years, had complained that the procedure was unnecessarily rough and prolonged, and had resulted in bleeding, puffy and infected gums, as well as severe cold sensitivity. The patient had attended his medical practitioner who had diagnosed gingival infection and prescribed antibiotics.

Unfortunately, this patient was convinced that the hygienist had either used non-sterile instruments that caused the infection or had failed to prescribe antibiotics for the gum infection which he felt must have been visible at the time of treatment. The receptionist had recorded in writing the details of the complaint, and the practice, which was part of a large group of practices, had forwarded the complaint to the hygienist for a response.

The hygienist felt overwhelmed by the situation and also “outranked” by the medical practitioner’s diagnosis, and unfortunately dwelled on the complaint for a few days before contacting Dental Protection. A suitable letter was writing showing sympathy for the patient’s discomfort and a detailed explanation of the treatment and likely cause of the postoperative symptoms (including the effects of this patient’s low dose aspirin medication).

Unfortunately, the practice manager insisted on reviewing the letter before it was sent and awaited the principal dentist’s return from an overseas wedding, as she had concerns about the sympathetic style of the letter and the use of the words “I am sorry that…..” – worried that this may interpreted as admitting liability. This delay left the patient believing that no reply was forthcoming and he formalised the complaint to the AHPRA.

The hygienist was, in time, cleared of any wrongdoing, with a response assisted by Dental Protection relying on instrument tracking and the Therapeutic Guidelines Oral and Dental for antibiotic usage protocols. This was a fortunate outcome, though the AHPRA investigation did note the member’s lack of response to the complaint (until too late). Being the subject of any investigation by a regulator such as the AHPRA is understandably a very worrying time for any dental practitioner, and the process is necessarily time consuming, both in responding to the complaint and waiting for a decision back.

Learning points

We will never know whether this complaint would have been resolved simply by a timely response of sympathy and explanation, but we do know the patient’s decision to escalate the complaint was  based on the lack of a reply and the feeling that he was not being listened to and taken seriously.

The role and place of antibiotics in dentistry is unfortunately a poorly understood process by many of the general public, and often the subject of patient complaints. Dental Protection can guide you towards appropriate references to reflect protocols for non-usage of antibiotics.

The member was feeling overwhelmed and unsure of how to deal with the complaint. She also felt that the practice had left her isolated in demanding that she deal with the complaint personally and had little experience with a complaints processes. Fortunately, the experts at Dental Protection deal with these situations on a daily basis and could provide advice on responding appropriately. When the complaint became an AHPRA investigation, Dental Protection could again guide the member through the process and provide collegiate support through the anxious wait for a decision.

After the complaint had been resolved, Dental Protection encouraged the member to discuss the delay in replying, caused by the practice wishing to review her response. While a practice owner’s desire to review any reply involving their practice is understandable, it is the individual practitioner’s responsibility to respond to a patient complaint. If a complaint is received by the AHPRA it will be directed at the practitioner personally and not the practice. These discussions resulted in a streamlined process for the practice to deal with any future complaints, recognising the need to support employed practitioners in the process and accept the role of dentolegal advisers in providing expert support to the member involved.

These case studies are based on real events and provided here as guidance. They do not constitute legal advice but are published to help members better understand how they might deal with certain situations. This is just one of the many benefits Dental Protection members enjoy as part of their subscription. 
For more detailed advice on any issues, contact us

© 2019 The Medical Protection Society Limited

DPL Australia Pty Ltd (“DPLA”) is registered in Australia with ABN 24 092 695 933. Dental Protection Limited (“DPL”) is registered in England (No. 2374160) and along with DPLA is part of the Medical Protection Society Limited (“MPS”) group of companies. MPS is registered in England (No. 00036142). Both DPL and MPS have their registered office at Level 19, The Shard, 32 London Bridge Street, London, SE1 9SG. DPL serves and supports the dental members of MPS. All the benefits of MPS membership are discretionary, as set out in MPS’s Memorandum and Articles of Association. “Dental Protection member” in Australia means a non-indemnity dental member of MPS. Dental Protection members may hold membership independently or in conjunction with membership of the Australian Dental Association (W.A. Branch) Inc. (“ADA WA”).

Dental Protection members who hold membership independently need to apply for, and where applicable maintain, an individual Dental Indemnity Policy underwritten by MDA National Insurance Pty Ltd (“MDA”), ABN 56 058 271 417, AFS Licence No. 238073. DPLA is a Corporate Authorised Representative of MDA with CAR No. 326134. For such Dental Protection members, by agreement with MDA, DPLA provides point-of-contact member services, case management and colleague-to-colleague support.

Dental Protection members who are also ADA WA members need to apply for, and where applicable maintain, an individual Dental Indemnity Policy underwritten by MDA, which is available in accordance with the provisions of ADA WA membership.

None of ADA WA, DPL, DPLA and MPS are insurance companies. Dental Protection® is a registered trademark of MPS.