Top five reasons for dental complaints – treatment issues
In the first of a new series, Alison Large examines the most common factors in dental complaints and how to avoid them.
Nobody wants to receive a complaint, but they are part of everyday practice and, if handled well, can be a worthwhile experience for you and your patients.
Over a recent five-year period, we assisted dental professionals with more than 9,000 patient complaints. In fact, complaints are the most common reason for dental professionals to call the Dental Defence Union’s (DDU) advice line.
NHS statistics show dental practitioners receive thousands of complaints every year. In 2018/19 there were 14,000 NHS complaints, a 10% increase on the previous year’s figure of 12,700.
So, what are the common issues patients complain about? Using a sample month of complaints notified to us by members, here are the top five reasons:
- Unsatisfactory clinical treatment or examination – allegations of poor technique, adverse incidents, poor treatment outcomes or treatment outcomes simply not meeting the patient’s expectations
- Delayed diagnosis – alleged failure to spot obvious signs of decay, gum disease or oral cancer
- Communication problems – misunderstandings surrounding treatment advice or possible complications
- Fees/charges – confusion over the cost of treatment, whether it was being provided on an NHS or private basis
- Staff attitude/behaviour – allegations of rudeness or an unsympathetic manner.
Over a series of five articles, the DDU will highlight some common themes and areas of risks to help you manage and reduce the risk of receiving complaints.
Dental treatment issues
This article examines the most common cause of complaints, which arise from unsatisfactory treatment or examination. Take the following fictitious example, based on DDU files.
A 25-year-old patient with no previous fillings registered with a new practice. At her first consultation, a bitewing radiograph revealed a significant carious cavity within the mesial aspect of UR4. The dentist explained his findings to the patient who gave her consent for a filling, but expressed concerns about the effect on the appearance of her teeth.
When the patient returned, the dentist restored the tooth with an amalgam filling, but the tooth lost vitality and she eventually required endodontic treatment. She later made a complaint about the adverse aesthetic impact of the silver filling and the failure of the treatment.
A practice investigation revealed a breakdown in communication between the dentist and patient. In particular, the dentist acknowledged he should have taken more time to highlight the decay revealed on the radiograph image; explained it was difficult to be certain about its extent; and warned there was a risk that root canal treatment might be necessary. He also agreed he should have made clear why an amalgam filling was more appropriate in this instance and checked the patient’s understanding.
The complaints manager wrote to the patient, admitting failings when managing her treatment. As a goodwill gesture, the practice offered to partially refund the cost of the patient’s root canal treatment. The patient was satisfied with this response and the complaint was resolved.
A significant number of complaints about poor treatment reflect technical failings by the practitioner. However, many cases also stem from communication issues with patients unhappy the treatment outcome had fallen short of their expectations.
Points to consider
- Gaining the patient’s trust, and establishing an honest and open dialogue are often as important as a dental professional’s operative skill
- It is essential to communicate effectively with patients. Carefully manage their expectations and note any warnings given about the limitations of treatment in respect of the patient’s circumstances
- When obtaining patient consent, take time to explain the treatment benefits, risks, complications and alternatives (including no treatment). Make a careful note of the discussion in the clinical records
- Recognise the limits of your clinical skills. Prepare to refer the patient to an appropriate colleague if complications are likely, or if the patient has a complex history
- Be aware of current guidance to make sure treatment is evidence-based
- Apologise and provide an explanation if things go wrong. The offer of appropriate remedial treatment at no further cost to the patient and/or a refund of fees, or other goodwill gesture, can often help resolve a patient’s concerns
- Get advice from the DDU or your own dental defence organisation if you need any further advice or support.
Ultimately, there are many factors that might contribute to an unsuccessful treatment outcome, from a recognised complication to the patient’s unwillingness to follow postoperative advice. However, patients may only accept these scenarios when explained in advance. If they are informed after something has gone wrong, these explanations can easily be dismissed as excuses.
The good news is – in the DDU’s experience – your in house team can successfully resolve most complaints.
Next time, we will examine the issue of delays in diagnosis.
The DDU’s website – www.theddu.com – has advice on dealing with complaints, including a free online learning module for members.