We live in one of the most litigious societies in the world. As dentists, we also work in one of the most litigated professions. It’s therefore not surprising that 8 out of 10 dentists claim that the threat of complaints or litigation has caused them stress.
When you put it like that, it does make you wonder what sort of person would ever subject themselves to our careers! We all have personal reasons for why we do what we do. It’s not for us to say why you should or shouldn’t stay in the profession.
However, there are many simple steps we can all take to reduce the risk of having to deal with these unpleasant circumstances. Let’s dive into the most common types of litigation, how you can balance competence and communication, and the tools you can implement to protect yourself in case of complaints.
Plus, we give some practical advice for responding to complaints.
Why do patients make complaints?
First of all, it’s a smart idea to look at why patients complain and what they most commonly complain about. Nearly everyone is looking for the same basic result from their complaint.
If someone feels they have not been treated fairly, they want to be given time to discuss what it is they are not happy about openly. Without interruption.
They want to feel listened to, heard, and know that their complaint is being taken seriously. I think we could all agree that this is perfectly reasonable.
What the data says about litigation
Periodontal cases have the highest claims for total payouts after litigation. This is closely followed by implant cases, which often come down to periodontal management.
There are a few reasons for this. Firstly, the primary reason for patients to make a claim is usually failure to diagnose. More specifically, failure to record and make that diagnosis known to the patient. The knock-on effect of that is that the patient doesn’t take control of managing their periodontal disease.
Many years down the line, when teeth are at risk of being lost, they may claim ignorance. Some will say they would have quit smoking and improved their oral hygiene routine - if only knew this would make a difference.
Periodontal disease is costly and extensive
The increased cost of this litigation is often due to periodontal disease affecting an entire dentition. Compare this to not diagnosing a single instance of caries, resulting in the loss of a single tooth. I know which one I would prefer.
Another unfortunate aspect of periodontal disease is its chronic, silent nature. A patient could suffer from periodontitis for decades without any symptoms until one day they notice their teeth wobbling. This results in practitioners who have long since moved on being dragged back into treatment disputes years later.
Even if you only see the patient once, inform the patient if you spot periodontal disease! Better yet, also write in your notes that you informed the patient. You'll thank yourself in the future.
Don’t just be Mr Nice Guy
Of course, you need to balance competence and communication. Sure, you might avoid complaints throughout your career purely because your patients love you.
Most of us will have heard stories of associates running new practices only to discover patients have been under-managed or neglected for years. Those dentists may never have had a single complaint from their patients. But those patients don’t necessarily know what good looks like.
Gaining trust from new patients can be a difficult process. Moreso if your treatment style is more competent than anything they may have previously experienced. However, building trust and rapport with patients is fundamental to avoiding complaints.
Rapport is the key to building trust
It’s human nature not to want to upset people. It’s in our own long-term interest to do what we can to form lasting relationships with all of our patients. Leaving a good impression will keep patients returning and even mean an increase in referrals.
In general practice, we have a privileged environment to do this. Some of us will see and treat multiple generations of the same family. That's something that very few healthcare professionals have the luxury of.
The difficulty in relying solely on your patients liking you is that even the most charismatic of us cannot be everyone’s cup of tea! You need to be competent too. Luckily, communication is a skill that can be learned.
Communicate, Communicate, Communicate!
With experience and practice, we all develop communication skills. In addition to what we say, we must also listen to what our patients are telling us. This is pretty fundamental if you want to avoid complaints, in particular those that might lead to litigation.
The majority of us have had at least one "never should have started" incident. We all know the faint alarm bell that rings just before we take that first step, whatever triggered it.
The most significant thing is that you take a step back and listen to it before proceeding further. We might not be able to pinpoint exactly what it is but we can usually tell when the dentist and patient are not on the same page.
Take a step back to consider the next steps
We can then ask ourselves, 'Am I providing a proper service by continuing to treat this patient, knowing that they are not fully on board?' In this situation, patients will often appreciate your honesty in suggesting that you may not be the right dentist for them. They will usually confirm your gut instinct and both parties can part ways before things turn sour.
In a minority of cases, it may be something totally unrelated that is giving you these signals. By saying something, you open the door to a candid discussion and prevent misunderstandings. By ignoring those gut feelings and withholding communication, we increase the risk that a patient will complain.
Another key aspect of communication with our patients is setting realistic expectations.
Don’t promise something you can’t deliver
An extreme example is the elderly toothless patient with severely resorbed alveolar ridges. Alongside an extremely dry mouth and multiple dentures, they’re complaining that they can’t eat a well-done rump steak.
Unless you are an experienced specialist prosthodontist (e.g. Finlay Sutton), you can almost guarantee that you can’t provide a set of dentures to solve this problem. It is in everyone’s best interests that you communicate this from the very beginning.
Conversely, if you have a patient with reasonable expectations and you under-promise then over-deliver, they will sing your praises everywhere they go.
Don’t leave yourself open
A lot of what we have already discussed will quite often fall into the “best-laid plans” category.
Sometimes we miss the red flags. We don’t realise we have said something to upset the patient. You've had a stressful day and have forgotten to do a BPE for the first time in your career.
When we receive a complaint of any kind, our first defence is the strength of our clinical notes. Gone are the days when “exam S+P” would suffice. There are many things that practitioners miss about those days, but it’s very unlikely they will ever return.
Writing notes for a single patient can take upwards of 10 minutes unless you have the right tools at hand.
In a situation like this, something has to give.
The dentist’s dilemma
The dentist has two choices. They end up running late and staying behind at the end of the day, trying their best to keep their records up to standards. Or, they start cutting corners and missing bits from their notes.
Dr Ruth Baidoo has faced this struggle and initially went with option one:
“Many of the problems with traditional note-taking are because of the sheer problem of what you need to write to cover everything. With that, there can be a fear that you might miss something or not include enough information, so you would usually write more than you needed.”
The latest blow to dentists at their wit's end with clinical records is the growing trend that pre-filled and amendable templates are risky. There are now cases where dentists have been criticised because they haven’t deleted sections such as ‘advised to quit smoking’ when the patient has never smoked.
The argument is made that the rest of the notes cannot be relied on because it hasn’t been customised to that patient. Dr Marcus Green confirms this is something that causes concern for dentists, saying
“Solutions like note templates and quick notes help, but there is always a nagging fear that you might not delete something from an existing list or skip over something important”
This is where Kiroku is changing the world of dental notes.
Mitigate risk with the right tools
Not only is it blazingly fast and easy to complete notes, it actively improves the quality of your notes.
Whenever you click that the patient smokes 10 cigarettes a day, Kiroku can populate the discussion section saying that you have advised them to stop. It also serves as a prompt for you to actually give this smoking cessation advice during the appointment!
If for whatever reason, you don’t give any of the recommended advice, you can easily delete any Kiroku-populated information that’s not relevant. Or, you can add anything that comes up in conversation to your notes. This removes the risk of being accused of not customising your notes for each patient.
More peace of mind than pre-populated templates
Kiroku relieves the stress that is still commonplace with using pre-populated templates for your notes. According to Dr Green “[Kiroku] acts just like a flow chart but with no real worries about leaving something in that shouldn’t be there, and it’s straightforward to see if any boxes have been left unticked.”
Dr Carl Horton also agrees, saying “The templates automatically eliminate irrelevant options as you start to complete the information, which keeps your notes tidy and as clear as possible for the next person who may need to access them. This simplicity was exactly what we needed.”
Dr Baidoo, who openly admits that she thought she’d go back to hand-writing notes before she trialled Kiroku now can’t imagine not using it. “Kiroku has really helped as the majority of the template is done for you, prompting you to add relevant information. This makes it less likely that I’ll forget to include something. It really takes the pressure off.”
As if that wasn’t impressive enough, Kiroku even has an audit feature for exam notes. It is supported by the UK’s FGDP so that you can see what is missing from your notes to bring them up to the gold standard.
When you have iron-clad notes made with Kiroku, if the lawyers start probing they’ll give up quickly. They'll notice it’s not going to be an easy fight because you have created thorough and personalised notes.
What can you do to respond to a complaint?
First of all, contact your indemnity provider before you do anything. The tendency to recommend financial compensation is one of the complaints dentists have about their indemnity providers. Understandably, dentists are reluctant to do this, especially when we feel we have done nothing wrong.
However, it is certainly one of the easiest and quickest routes to resolution. If you and your indemnity are confident that it is a fight you can win and you have the energy to carry through with it then, by all means, take it as far as you can.
If, however, you have a lot already on your plate and don’t feel you can take on any more, offering a goodwill sum can make the headache go away as quickly as it arrived. Whether this is positive for the profession, on the whole, is a debate best saved for another forum.
Leave a paper trail
Some form of written communication is usually needed as a response to a formal complaint. Your indemnity providers are exceptionally experienced in producing these letters and they know exactly what to say to calm situations effectively.
The general points of these letters include:
- Apologise for the patient’s negative experience. Note: An apology is not an admission of guilt!
- Show the patient that their complaint is relevant and valued.
- Let them know that their feedback will be used to improve the service of all patients.
- Be honest and transparent about the events that took place and how their complaint will be handled.
Most of all, it is extremely important for clinicians not to allow their emotions to rule their response. None of us likes to hear that our patients aren’t happy. If we allow ourselves to give in to emotions and retaliate, it is never going to end well and is likely to escalate further.
In addition to helping you with individual cases, all indemnity companies have vast resources available to them to help you protect yourself. If you are looking for more detail about any of the points we’ve discussed, Dental Protection has an excellent handbook for handling complaints.
Don’t let it knock you down
The most significant thing to take away is to be passionate about your profession, dentistry, and caring for your patients. Dentistry is full of inspiring people and when we put all of that energy into looking after our patients, everything else tends to fall into place.
If you want any advice on how to improve your note-taking skills so that you can avoid the headache of litigation down the line, please reach out to us and we’d be happy to put you in touch with any of our Kiroku community.
