David Lauder examines the most common factors in dental complaints and how to avoid them.
Communication problems are a common causes of complaints against dental practices. They account for around a third of complaints notified to the DDU. Breakdowns in communications are often an underlying factor in complaints. Even if it is not the patient’s main allegation.
Of course, patients who are upset, anxious or in pain can make communication more challenging. But good dental care is dependent on a good rapport between clinician and patient. Failing to communicate clearly leaves advice or warnings open to misinterpretation. This can result in confusion for patients. And it can be hard to get things back on track if a patient feels they’ve been misinformed.
Having reviewed a sample month of complaints notified to us by members, cases in this category primarily concerned allegations of poor communication and inadequate oral health advice provided to patients, such as the presence of gum disease or decay. Several complainants focused on the communication of treatment decisions. For example, whether it was appropriate to prescribe antibiotics. There were also a number of complaints about the service provided by the practice. Such as late-running appointments and the practice complaints procedure.
Dental professionals have an ethical obligation to communicate effectively with patients. This is set out in principle two of the GDC’s Standards for the dental team. It’s vital that everyone in a patient-facing role has the necessary skills and receives training if required as in the following case.
Case example
The following fictitious example, based on DDU cases, illustrates how a practice managed a communication problem.
A patient went to see his dentist for emergency treatment after cracking a tooth. It was an unusually busy morning for the practice because one of the dentists was off sick. This left the patient waiting for an hour.
During the consultation the patient objected that other patients who arrived later had been seen before him. The patient became quite agitated and said he felt he was being ignored and that no one at the practice seemed to care about his discomfort.
The dentist apologised for the delay and said he would look into the patient’s concerns. A few days later, after investigating the issue, the practice sent a letter, explaining that the practice saw the patients with appointments in sequence. It accepted that the practice should have communicated better by explaining on arrival that the dentist would see them when time became available and set out how it was addressing this issue. At the next consultation the dentist saw the patient promptly. They thanked the dentist for looking into his complaint and for the professional way the practice had responded.
Perhaps the most important principle of good communication is that it is a two-way process. Listening to patients and understanding their wishes and expectations is as important as what you say. By making the effort to communicate clearly and concisely with patients, practices can minimise the risk of a complaint and can often help to resolve complaints at an early stage.
Points to consider
- Good communication starts from your first consultation. Introduce yourself to the patient and explain your role in their care
- Be an active listener. Make eye contact, nod or say ‘I understand’ occasionally to acknowledge the patient. But try not to interrupt or put words into their mouth
- Check the patient’s understanding, especially when explaining complex treatment plans. Use signs of anxiousness or confusion as a cue to ask questions
- Use simple terms and avoid jargon or large amounts of clinical information when explaining treatment options. Don’t assume a patient understands exactly what a procedure involves, even if they appear well-informed
- Put in place a system to identify patients with communication difficulties and take reasonable steps to help patients. For example, provide an induction loop for those who use hearing aids; consider whether those who don’t speak fluent English may benefit from the presence of an interpreter
- Encourage patients to set out their priorities and concerns and address these directly when discussing treatment options
- Explain potential complications in advance so patients can prepare
- Review your practice website, correspondence and advertising to ensure everything is clear
- Patient surveys are useful in assessing the strengths and weaknesses of communication within the practice. Are the dental professionals providing their care approachable? Do patients understand the information provided? Do they feel the practice is listening to them?
- Tell patients how to contact you by their preferred method of communication. Explain who to contact in an out-of-hours emergency.
If you face a complaint, the DDU or your own dental defence organisation can help you to address the concerns raised. A well-drafted response to a complaint will often result in resolving matters to the patient’s satisfaction. This is the most common outcome in the complaints we see.
Next time we’ll examine in more detail how treatment fees can cause complaints. The DDU’s website www.theddu.com has lots of advice on dealing with complaints including a free online learning module for members.
