The COVID-19 files – ‘unsatisfactory treatment’
The pandemic interrupted many long-term courses of treatment making it harder for dental professionals to deliver their usual standard of care. Unfortunately, this is likely to increase the number of complaints about unsatisfactory treatment, a trend we began to see in 2020. Here Angela Love, dentolegal adviser at the DDU, discusses some of the common themes and our risk management advice.
Unhappiness with the outcome of dental treatment has always represented a high proportion of the DDU’s complaints files. Although such complaints might previously be due to human error, the pandemic has demonstrated that things are seldom so clear cut.
There are often multiple factors that contribute to an unsuccessful outcome. For example: the patient’s general oral health, their ability to follow dental advice and whether they have realistic expectations.
During the pandemic, the risk was heightened as treatment plans were put on hold. It was harder to maintain patients’ oral health, which increased the chance of a poor outcome.
Analysis of complaints files opened by the DDU between 15 March and 1 December 2020 showed that ‘unsatisfactory treatment’ accounted for 40% of cases.
While the number of complaints was relatively low during this period because of the pause to routine treatment, we have started to see an increase in such complaints. We think this trend will continue in the coming months.
The recurring themes are:
- Patients unhappy about the interruption in their treatment and suspension of dental services
- Problems with orthodontic treatment plans. Especially where some relapse occurred due to breakages of the appliance. Patients were understandably frustrated by these complications and delays
- Patients who believed they received unsatisfactory treatment before the pandemic and were unable to have their concerns addressed because of the pandemic
- Concerns about emergency treatment, such as extractions. This includes patients who were unhappy that it wasn’t possible to have root canal treatment to save the tooth.
The following fictitious scenario, based on DDU COVID case files, illustrates a typical complaint.
A man in his sixties was fitted with a partial denture a few months earlier. But a clasp broke while he was eating.
The patient made an appointment at the practice to fix his denture. But dental services were suspended before this could happen.
The patient left messages with the practice over the next few weeks, complaining that the denture broke because it was poor quality. He then wrote a letter, demanding that the practice investigate the laboratory making his denture and refund the cost. He complained that the denture was too loose to wear. But he could not leave the house at all with missing teeth.
The practice complaints manager investigated and discovered that no one responded to the patient’s telephone messages due to a breakdown in communication at the practice.
She wrote to the patient apologising for the delay in addressing his concerns, explaining what had gone wrong and how the practice planned to ensure an error like this did not happen in future.
As a goodwill gesture, the practice agreed to refund half the cost of the treatment and repair the denture at no extra cost. By this point practices were able to resume treatment. She was able to offer the patient an early appointment to fix the problem.
The patient welcomed the practice’s constructive response and the complaint was resolved.
It is impossible to completely rule out the possibility of unexpected technical problems during treatment. But the following tips should help you reduce the risk and manage patient expectations.
- Ensure you have enough training and sufficient experience to carry out a procedure. Assess the situation, bearing in mind the potential complications and the degree of difficulty in providing that item of treatment for the individual patient. If you are unfamiliar with a treatment, seek advice and prepare to refer the patient if clinically indicated
- Always be realistic about the prospects of treatment. It’s natural to want to remain positive about what you can achieve. But you should be up front about the risks too
- Make detailed notes about the patient’s priorities and treatment concerns so you can address these during the initial consultation and throughout treatment. Especially if circumstances change
- Discuss the possible complications of treatment with the patient as part of the consent discussion. Ensure they are aware of all the treatment options, including no treatment. For informed and valid consent, you must cover the recognised complications and the risks that the patient is likely to consider significant
- Provide clear information on what patients should do if there is an emergency. For example an appliance breaks, they are in pain or have a suspected infection
- Ensure the practice has a system in place to triage emergencies. And that the website/answerphone system explains how patients can access urgent care outside usual practice hours
- If something goes wrong during a procedure, tell the patient immediately. Apologise and explain what you propose to do to manage the situation
- It is a good idea to check the progress of long-term treatment at regular intervals, especially after a prolonged interruption to treatment. Prepare to reassess your treatment plan with the patient’s consent. Issue an amended plan in writing and include a cost estimate.
For more information about the DDU, visit www.theddu.com.