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Symbolic atonement

24 September 2018

There are occasions when Dental Protection will advise financial redress in circumstances where it would seem this is simply responding to the patient’s demand. Dr Jane Merivale, head of policy and technical at Dental Protection, explores the rationale for such a recommendation

Patients may voice dissatisfaction directly or in writing. Either way this is distressing and begs the question, what is the patient saying and trying to achieve – an apology, a remedy, an expression of sympathy or empathy, accountability or just revenge?

In today’s culture there is an unfortunate attitude that when something isn’t to a person’s satisfaction or indeed the outcome isn’t what was anticipated or hoped for, then someone must be at fault and ‘someone’ or some organisation will have to pay, either literally with financial redress or reputationally. The latter is all the more worrying with the opportunity for online comments available at the click of a finger.

We encourage Dental Protection members to seek advice as soon as a complaint is received to obtain professional advice and, importantly, to avoid the possibility of compromising the future handling of the complaint. A poorly worded response is difficult to undo and can be professionally embarrassing if aired in another forum.

How we handle a complaint

At Dental Protection, the complaint will be assessed and the dental records evaluated by one of our dental advisors. The skill is to ‘horizon spot’: to assess if the complaint has merit and where it may land if it is not resolved at the earliest opportunity. This assessment relies on both clinical expertise and the experience of having handled many complaints. From the available information the adviser will looks at what has happened (the treatment or lack of) and how the care has been delivered.

The technical focus is to identify any element of the clinical treatment that could be regarded as below a reasonable standard (a breach in the duty of care) from which some problem has resulted (causation). If so, then the advice would be that the complaint has the makings of a claim if the patient decided to instruct a solicitor. The records would then be subject to scrutiny by an independent expert.

The complaint is also evaluated to see if there is any aspect that could give rise to criticism should the patient draw their concerns to the attention of the regulator. The focus then is more on how the treatment was provided; the attitude and behaviour of the registrant, as well as the treatment itself.

Early resolution in either scenario is advised in an effort to resolve the complaint at a local level, and to hopefully avert escalation along either of the above routes.

However, nothing is ever quite so straightforward and there are times when the complainant is dissatisfied and none of the above vulnerability is identified. What then?

That refund demand

A well drafted letter, explaining the care provided (supported by the contemporaneous records) and an apology that the person has found the need to complain may suffice, or it may not; the complaint remains and the demand for a refund is all that sits between escalation and resolution.

We often hear “on a matter of principle, as I’ve done nothing wrong, I will not give in and refund”. Here the concept of the ‘no negligence loser’ can be considered. In a sense, someone has to defuse rather than aggravate the situation, and make every effort to draw the unhappy situation to a close. A failure to do so could cost time whilst a third party explores the issues raised, additional money and a loss of practice goodwill and local reputation. Human nature being what it is, the facts are likely to be shared inaccurately and exaggerated.

And so to the concept of symbolic atonement: giving the ‘customer/patient/client’ something to make up for the problem they’ve experienced. That something would usually be a refund of fees as a goodwill gesture, with no admission of fault, and accompanied by a kindly worded explanation. Research shows that a complaint handled well often enhances reputation and leads to customer loyalty.

There are a variety of reasons why a refund of fees will be advised, and the suggestion to do so will always be given with members’ best interests in mind.   


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