Dentist to dentist

“ANY DENTIST who has been in practice long enough,” says Claire Renton, “will know what it means to deal with a difficult patient or to be on the receiving end of a complaint.” Indeed this is somewhat of a guiding principle to Claire in her work as a dental adviser at MDDUS. We chat during a morning off from taking advice calls in her Glasgow office.

“We’ve all carried out treatment for patients that for one reason or another just hasn’t worked,” she explains. “But that doesn’t mean you set out to do things badly.”

Claire joined the dental advisory team at MDDUS in 2009 and in that time has dealt with many distressed members. She says: “A lot of our work is dealing with patient complaints against members. It can be difficult for dentists because in most cases they will have been bending over backwards, doing their very best for somebody. Quite often it’s the patient seen at lunch time or out of hours. So the dentist – quite rightly – feels aggrieved when they subsequently make a complaint.

“And patients complain not only about the dental work itself – a crown not fitting or falling out or breaking – but often add on things like ‘and I spent hours at your surgery and I want you to compensate me for my time off work’. So there can be a lot of emotional baggage attached to complaints.”

Dealing with that emotional baggage is all part of the job as an adviser and requires a high degree of understanding and empathy. Just as with all the professional advisers at MDDUS Claire brings a broad range of experience to her role.

Legal interest

Claire qualified as a dentist in 1985 after graduating from the University of Glasgow. Her first job was as a house officer at the Glasgow Dental Hospital and then an SHO in oral surgery at the Victoria Infirmary. After working as a registrar, she accepted a five-year lecturing post in Adult Dental Care at Glasgow University.

In the meantime she married her husband Rod, also a dentist, and they had three children. On completing her university contract Claire decided to go part-time as a GDP and eventually went to work with her husband in their practice in Bearsden, north of Glasgow.

In that period she also rekindled an old interest in law and ethics. Claire says: “I had always been quite interested in legal matters. Even as a student I thought I might do law. But my Dad was a dentist and I think that’s probably why I plunked for dentistry in the end.”

In her limited spare time Claire undertook a three-year part-time Masters in Medical Law at the University of Glasgow. Not long after completing the course a job at MDDUS became vacant and the organisation was keen to appoint a dentist with her breadth of experience.

Being pragmatic

The dental advisory team at MDDUS operates out of two offices in Glasgow and London. Part of the job involves fielding calls from members phoning into a 24/7 advice service. In 2011, dental advisers at MDDUS dealt with around 2,500 advice requests. Among the most common topics are those relating to difficult patients, dealing with complaints, dental record keeping, problems with colleagues and treatment planning.

“There is certainly an important preventative element to the work we do,” says Claire. “And we welcome calls at the earliest outset of a problem. It’s really heartening when a dentist phones up and says: ‘I’ve had a patient in today. They haven’t complained, they haven’t said anything yet but I’m just concerned something is going to happen.’ This is quite helpful because you can advise them maybe to get a second opinion or ask if they have thought of this or that.

“In fact much of the job is just knowing how to be a pragmatic, sensible dentist. What would you do in the same circumstances? The advice we give may be based on a knowledge of rules and regulations but you must translate that into a practical solution.”

In the hours not spent on telephone duty Claire works with an inhouse legal team managing cases that have escalated beyond a complaint to either a civil claim or disciplinary action from a health authority or the General Dental Council. Typical cases might involve problems with treatment such as a failed implant or a dentist neglecting to obtain clear informed consent for a procedure, or a dispute over charges. Here the dental adviser acts both as a facilitator and brings their clinical dental experience to the case.

“We are the main contact with the member,” says Claire, “moving things forward and acting as a liaison with the lawyers. We also look at the dental issues and help form a defence, if possible, directing the solicitors to current dental guidelines and regulations. We assess the case initially and judge the possible outcome.”

Advice and reassurance

Dentists facing professional difficulties will often meet with an adviser either face-to-face or via video link to discuss evidence and what processes are involved in legal and regulatory cases. Often an adviser will attend hearings with the member to offer advice and reassurance.

Says Claire: “I think one major frustration for dentists in these circumstances is the time it takes to resolve a case. It can be months or even years from the initial solicitor’s letter to getting it all settled. And that can be quite stressful for dentists. It’s always churning at the back of your mind. So a lot of our job is to reassure the member that we’ll handle it, take the heat out of things and sort it out for them.”

Asked about what sorts of cases she finds most difficult to deal with, Claire replies: “The ones where the members don’t engage with the process – take a head-in-the-sand approach. It’s difficult to get them to participate and have some insight into the situation. Either they are scared by the whole process or just have no concept of the seriousness of it.”

But most members cooperate fully to help resolve cases as quickly as possible. This includes providing a comprehensive account of the facts of a case supported by the patient records.

“Records are hugely important,” says Claire. “Because cases are defended on what’s written down. You might say that my usual practice is to say this or do that, but if it’s not in the records it’s subject to reasonable doubt.”

Claire is philosophical about much of what crosses her desk in the course of a week. Dentists do sometimes make mistakes but she has no doubt that the vast majority want only to do the best job possible for their patients. Many complaints and cases she feels are simply the product of a growing blame culture.

“Everyone in this country knows that in order to keep your teeth you need to brush twice a day and floss. And yet some patients still ignore this basic preventative advice and when things go wrong look for someone to blame. Dentists are slightly sitting ducks in that regard. It’s often a nonsense but that’s the world we live in.”

And the job of professionals like Claire is to provide some redress against this tide of blame.

Profile by Jim Killgore, editor of MDDUS Summons