The COVID-19 files – managing pandemic communication

communication with patientsLeo Briggs discusses some of the common themes surrounding communication in practice and details the DDU’s risk management advice.

The emphasis on social distancing and wearing personal protective equipment (PPE) during the pandemic was always likely to make communication more difficult. It is no surprise that this was one of the issues that prompted requests for advice and support from Dental Defence Union (DDU) members in 2020.

Communication issues have always been one of the top reasons for patient complaints in dental practice. The pandemic has put dentist-patient relationships under even greater strain.

The abrupt halt of routine appointments in March 2020, for example, meant many courses of treatment went on hold. Difficulties in accessing emergency treatment left some people in pain. Some practices were unsure how best to communicate the rapidly changing situation to their patients.

Most patients were understanding about the necessary compromises in dental services. Although, practices also had to contend with the impulse to ‘shoot the messenger’ from those who felt let down or frustrated.

Communication issues

An analysis of more than 500 advice and assistance files were opened by the DDU between 15 March and 1 December 2020. It showed that communication issues accounted for 23% of complaints and 2% of advice files. The recurring themes were:

  • Patient complaints about rude or unsympathetic attitude by dental professionals or practice staff
  • Objections to the practice enforcement of mask-wearing. This included allegations of discrimination by those who believed they should be exempt
  • Complaints from parents about being told they could not accompany their child to an appointment
  • Communication about access to dental care. This included patients being unhappy about the cancellation of their appointment or difficulties in arranging emergency treatment
  • Practices seeking advice about communication with patients ahead of the return to routine appointments. This included information about new virus control measures.

Case example

The following fictitious scenario, based on DDU COVID-19 case files, illustrates a typical communication complaint and how the practice responded.

A patient had started a course of orthodontic treatment at a general dental practice. Due to the pandemic, they suspended his treatment. They advised the patient that the practice would contact him to resume treatment as soon as it reopened.

When lockdown restrictions were lifted, the patient waited a week before calling the practice to make an appointment. However, they were told that nothing was available. The patient explained that he needed a new set of aligners. The receptionist responded that cosmetic treatment was low priority. She advised him to be patient and someone would contact him the following month.

The patient complained that the receptionist had been rude and patronising. He demanded a refund on his deposit because he was going to seek treatment at another practice.

Post investigation

After investigating, the practice complaints manager apologised to the patient for the way the receptionist had spoken to him. Then, they explained the context to the patient. They opened the practice that week. They were short-staffed and had a long waiting list of patients who needed urgent care.

She agreed that did not excuse what had happened. She reassured the patient that the practice had recruited another receptionist to ease the pressure. Lastly, she explained the priority groups for appointments and the likely timescales.

The patient thanked the practice for their response. They were able to resume his orthodontic treatment with the practice later in the year.

As in this case, a well-drafted response to a complaint will often result in matters being resolved to the patient’s satisfaction. Ordinarily, practices resolve most complaints but the pandemic has obviously stretched resources. Patients should be informed if your practice is unable to respond to a complaint within the timescale set out in your complaints process.

By ensuring patients know what to expect and keeping the lines of communication well and truly open, you can avoid escalating the situation and should avoid criticism. You should store copies of complaints communications separately from the clinical records.

DDU advice

If you have a concern about an aspect of communication during the pandemic, seeking DDU advice at an early stage can help pre-empt problems and reduce the risk of a complaint. The DDU also has these tips on managing pandemic communication:

  • Review your website so patients have a consistent and up-to-date message about how they can make an appointment and possible delays for routine treatment
  • Check your practice answerphone message provides clear instructions on how to access emergency treatment
  • Pre-appointment communications should be explicit about how you are following official guidelines designed to safeguard everyone. This includes the practice policy on access to the premises, sanitisers, mask-wearing and distancing
  • If patients attend without a mask, you can explain the government’s advice on the need for mask wearing on healthcare premises and offer them a mask to wear
  • Forewarn patients about the limitations of treatment options and possible delays in the management of referrals so they have realistic expectations
  • Communicating while wearing PPE can be challenging, especially for patients who are anxious or have hearing difficulties. While there are no easy answers, making eye contact will help. Also, speaking in short sentences and avoiding dental terminology. Be alert to non-verbal cues from the patient and ask them to repeat back what you have said to confirm they have understood
  • You may be under pressure but take time to talk to the patient about their concerns and empathise with their experience. Especially if they have had their treatment delayed or interrupted. A sympathetic approach will help gain their trust and make it easier to communicate
  • Ensure everyone in a patient-facing role has received training in communication. Consider whether to provide additional training in conflict resolution
  • Continue to encourage patient feedback so you can pick up possible issues before they become the subject of a complaint. Ensure patients feel at ease and well looked after during the pandemic.

For further information on the dentolegal implications for dentists during the coronavirus pandemic visit www.theddu.com/coronavirus.

This article first appeared in Dentistry magazine. You can read the latest issue here. 

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