There can be no doubt that dealing with patient dissatisfaction and receiving complaints are among the most challenging experiences a dental practitioner can face. Dr Mike Rutherford, senior dentolegal adviser at Dental Protection, explores these issues
A patient tells you they are unhappy with you and the treatment you provided. It is a heart-sinking moment, creating all manner of emotions, including frustration, resentment, a fear of being overwhelmed, a feeling of being 'deprofessionalised', anger, helplessness, hopelessness and powerlessness.[i] These feelings, while understandable, are also unhelpful in formulating your response to this dissatisfaction, as you may ‘react’ to the situation rather than ‘respond’ in a professional manner. They are also unhelpful to you, as they may lead to long-term stress and the consequences of this for your physical health and emotional wellbeing are well documented.[ii]
When we consider how to handle patient dissatisfaction or a complaint our approach should be threefold:
- resolve the patient’s concerns
- care for ourselves throughout the process, and beyond
- audit to safeguard against future complaints of this nature.
The first steps
A patient complaint needs to be acknowledged in a timely fashion. But what is considered timely? A review of the NZDA Code of Practice: Complaints and Criticism tells us this must be done at the first possible opportunity and within five days.[iii]
Acknowledging a complaint when it is being expressed to you directly is simple, although you should take care to respond appropriately and not ‘react’ to this potentially stressful situation. Many practitioners, however, forget to acknowledge a written or emailed complaint. As part of this acknowledgement the patient’s expectations regarding ‘what happens next’ need to be set, and you need to consider if the patient needs to provide any additional information? For example, the records of or a report from their new treating dental practitioner, and request this if appropriate.
At the initial stage of having received a complaint, it is not necessary that a full reasoned response be provided, but rather an acknowledgement to your patient that their complaint has been received and that you intend to reply comprehensively. The NZDA Code of Practice: Complaints and Criticism states:
“Consideration and patient advised of outcome of progress with the complaint within 20 days.”
This should get you through the acute phase of receiving a complaint. It is important that every staff member who deals directly with the public has the ability and training to be the ‘first responder’ to a complaint, as not only will this give them greater confidence when these situations arrive, but better early management will render the complaint far less likely to escalate to a third party (such as the HDC). Staff can become defensive too and react when they believe that a complaint is being unfairly directed at them; or a patient is demanding an immediate response. A little training and a practice policy detailing steps to be taken can help both the patient and the staff member in these situations. Patients who complain and then feel that they have been ignored or, worse still, rebuffed, are more likely to escalate their complaint.
It can also be helpful to have a nominated ‘complaints officer’ at the practice. Preferably someone calm by nature, this person could have additional training in complaints management and should be a good communicator, to enable them to establish rapport with the patient. All future communications regarding the complaint can then go through them.
Work through the patient’s concerns to reach a resolution
The mechanism for doing this will vary from case to case and will depend on the nature of the complaint, the severity of the complained adverse outcome (if there is one) and its consequences for the health or wellbeing of the patient and, above all else, the willingness of both parties to engage in reasoned conciliation.
Regardless of the nature of the complaint, if you have any doubts about the approach to take or your ability to resolve it amicably, you should contact Dental Protection for advice. Our advisers are experienced in resolving patient concerns and, just as importantly, can be a sounding board for your thoughts and concerns. Information you provide us with and advice that we give remains confidential – except in some criminal events. We can provide an objective and expert (in the experienced dental practitioner sense) opinion on whether the complaint is reasonable, and tailor your response to suit the individual circumstances in a collegiate non-judgemental manner.
Take time for a debrief, and care for yourself
Feeling professionally challenged can be a terrifying and isolating experience. We may fear ridicule or a critical judgement from our peers as a consequence of the patient dissatisfaction, particularly if the patient had a genuine and legitimate reason to feel that way. We may feel that our reputation will be besmirched by a complaint and wish to keep the complaint or patient dissatisfaction to ourselves.
While all of these reactions are understandable, they will not be helpful to you in the long term. Sometimes, as in this case, the old clichés are the best, and a ‘problem shared is a problem halved’. Talking through our complaints, concerns and distress with others can enhance personal growth and understanding. Furthermore, discussing our difficulties with others can help them recognise similar issues before they arise, and help them to better manage patient dissatisfaction in their own practice.
Finally, something that can be helpful, although it seems slightly counter-intuitive perhaps, is to keep a complaint file. This is kept separate to the clinical notes for each patient. While this complaint file may sit empty for many years or it may only have one complaint in it, it is important to take the time to review any complaints received to see if there is a pattern of issues. Is it timekeeping, fees or the way that the practice is making patients feel? If so, what steps can you take both personally and through the practice to safeguard against complaints of this nature in the future?
Dental Protection can offer you both support and advice during the often stressful process of complaint management. We can assist with appropriate wording and help make this, as trying as it is at the time, a learning exercise for the future. The essential elements are that a sympathetic, polite and objective reply needs to be forwarded in response to a complaint in a timely manner.
[i] Mathers et al 1995, Butler et al 1999, Elder et al 2006
[ii] Bodner 2008
[iii] Code of Practice: Complaints and criticism 21 March 2015