Dental hygienists, dental therapists and oral health therapists leave their practices for a variety of reasons, and occasionally this can be due to a breakdown in communication and issues surrounding working relationships within the practice.
When a dental practitioner leaves a practice on bad terms it can be the catalyst for a number of unexpected patient complaints. This scenario can be difficult to manage if there is no agreement with the practice owner about how to manage post-treatment issues that would otherwise have been addressed by the practitioner had they remained at the practice.
It is common practice for an agreed sum of money to be withheld by the practice owner for an agreed period of time when a dental practitioner leaves a practice, to allow minor problems to be resolved.
Case study
The relationship between a practice owner and an oral health therapist (OHT) had deteriorated to such an extent that the OHT had left the practice.
The OHT was clinically very competent and experienced, and had completed a number of challenging anterior composite filling cases. One particular patient, Mr L, had been treated with composite build up restorations on numerous teeth to conservatively manage his tooth wear, and the finished result was satisfactory. Whilst the OHT’s clinical records reflected the merits and limitations of composite resin versus porcelain restorations, there was no mention that further charges would apply for the maintenance and/or repair of these restorations. When Mr L required some fairly minimal general polishing of the composite restorations due to surface staining, he said he had not been informed that additional charges would apply and did not expect the owner of the practice to charge him for this treatment.
Mr L resented being asked to pay for polishing the composites and raised the issue with the practice owner, who passed the complaint to his former OHT. Although the OHT had moved over 70 kilometres away, he offered to review the patient and provide the necessary treatment at no cost, but the patient was understandably unwilling to travel to see him.
This scenario was not an isolated example; it was a recurring story involving a number of patients who required similar maintenance work. Rather than completing this work as a gesture of goodwill to maintain the reputation of the practice, the practice owner encouraged every minor concern to develop into a complaint that required a formal response from the OHT. The fact that the patients felt they were being charged an over-inflated cost for maintenance treatment by the practice owner only added to their dissatisfaction.
The OHT contacted Dental Protection, and with the benefit of hindsight, realised that he had not made it clear to Mr L – or to the other patients – that ongoing maintenance would be chargeable. He recognised that there had been no clarity regarding what aspects of the treatment were covered by the original fee and, as a result, patients had unilaterally made some assumptions.
Dental Protection advised the OHT to talk to the practice owner and try and come to an agreement, so as to avoid further incidents that could be harmful to both their reputations.
The OHT and practice owner reached an agreement between them to cover the reasonable cost of post-treatment maintenance/polish appointments.
Learning points
- This case study illustrates the importance of maintaining professional relationships and taking the time to agree how patient care can, and should, be handed over when a dental practitioner leaves a practice.
- There should be a signed agreement that includes a clause regarding the retention of fees for remedial work when a practitioner leaves a practice. This avoids disputes and disagreements that may arise after the departure of a practitioner.
- When planning treatment that requires ongoing maintenance, clear explanations should be given to the patient and documented in the record. This should include an explicit statement about what the initial fee includes and what charges may apply in the future. This should be set out clearly in writing for the patient and a copy retained in the records, so everyone knows what to expect.
- Financial disputes between the practice owner and a dental practitioner should be resolved between the two parties and not involve the patient.