A proactive approach

NO ONE likes being on the receiving end of a patient complaint but it is something that will most likely happen at some point in your career. As a newly qualified dentist starting out in practice, the best approach to take when this happens is a proactive one which involves communicating effectively with the patient and maintaining high professional standards.

And while it may be tempting to put off thinking about a complaint until another day, it is important to always respond quickly and carefully as this can often defuse the situation and prevent it from getting out of hand.

Patient complaints are among the most common reasons dentists contact MDDUS for advice. Cases vary but evidence has shown that the manner in which a dentist initially deals with a patient query/complaint greatly influences the process and outcome.

This is clear in one recent case that centres around payment for treatment. In this instance, a patient asked her practice why she was being billed for two consultations instead of one because she believed the second visit was a continuation of treatment initiated in the first visit. This simple query soon escalated into a complaint amid accusations that the dentist behaved aggressively and failed to provide details of the practice complaints procedure when asked. The dentist also made matters worse by accusing the patient of being unwilling to pay for her treatment and suggesting she apologise to him.

The case was brought before the Ombudsman and the dentist was criticised for his handling of the complaint. Had the dentist simply listened to the patient’s concerns, explained why she was billed twice and provided any requested information, it would likely have gone no further.

So by following a few basic guidelines, you can help minimise the risk of complaints escalating into more serious matters.

A welcome ear

The importance of good communication skills in handling complaints – and also preventing them – cannot be underestimated. The General Dental Council’s guidance Principles of Complaints Handling advises: “Many complaints will not be about your technical skills or the quality of the clinical care you give to patients. Patients complain because their expectations of a good level of service have not been met. If a patient’s expectation does not match yours, this can often be the result of a failure to communicate.”

If you receive a complaint, more often than not it can be dealt with on the spot with an honest and direct explanation and apology (where appropriate). Giving patients time to explain their concerns, and listening to them without interrupting, can be enough to defuse the situation.

Active listening is key. It’s important to acknowledge the problem and invite the patient to air their concerns by saying something like: “I can see that this is a very serious issue for you. I am very sorry that this has not worked out as we both hoped. Please take your time and tell me what the problems are and then we can talk about how we can set them right.”

It’s important not to react defensively to complaints – patients have the right to ask questions, query treatment or raise general concerns. Dissatisfied patients can be fearful, mistrustful and angry; it’s important to defuse and not further inflame such emotions. Try to acknowledge and understand the anger a patient may be feeling – and don’t take it personally. It’s important to remain calm and courteous.

Active listening also involves summarising what the patient has been telling you and validating their concerns. For example: “Let me check I have understood you correctly; you are concerned that there may be some further infection in your tooth. I can understand that this would be very worrying.”

Saying sorry

Patients who complain are often just looking for a sincere apology and reassurance that a similar incident will not happen again to other patients. An obvious fear among healthcare professionals is that an apology may be interpreted as an admission of liability in any potential litigation.

But under the Compensation Act 2006, which applies in England and Wales, “An apology, offer of treatment or other redress, shall not of itself amount to an admission of negligence or breach of statutory duty.” And guidance from the Scottish Public Services Ombudsman advises that an apology “is not a sign of weakness or an invitation to be sued”, adding: “To apologise is good practice and is an important part of effectively managing complaints.”

Each patient complaint is different so advice will vary depending on circumstances but there can be no harm in a sincere expression of regret for the patient’s dissatisfaction. If in doubt, then seek advice from a senior colleague or from MDDUS for help with specific incidents.

Early warning signs

An important element of defusing complaints is in identifying them at an early stage. These can often start out as “comments” or “queries” or “suggestions”. For this reason, it is important to avoid being dismissive or insensitive towards such patient contacts as this in itself might lead to the complaint escalating. As always, you should be familiar with the GDC’s guidance Standards for Dental Professionals which sets out principles all dentists must follow when treating patients. Clearly, conforming to these standards of respecting patients, putting their interests first and maintaining your professional knowledge and competence will help to minimise the risk of patient complaints.

In addition, all dental practices should have a comprehensive policy in place for handling complaints that patients should be made aware of. Equally, dentists working in secondary care should be familiar with the health board/Trust complaints policy and advise patients where appropriate.

The GDC advises dentists to keep a written log of complaints “so that you can use this to monitor your performance in handling complaints and identify possible areas for improvement.”

A recent report from the Dental Complaints Service, which helps private dental patients, provides an insight into some common reasons for complaints and also suggests complaints levels are rising among this patient group. Their latest figures show the number of complaints received increased by 24 per cent last year, rising from 1,180 in 2009/10 to 1,559 in 2010/11. Of these, 67 per cent were resolved within a week.

By far the most common reason for non-clinical complaints was failure of treatment (862 complaints last year) followed by patients complaining they were uninformed (158) and post-operative pain (121). The most common clinical complaints related to crown treatments (239) followed by root canal (142) and bridge work (126).

However, the DCS emphasised that most complaints can be resolved “quickly and amicably” by working with patients and professionals.

Standards for Dental Professionals neatly summarises the GDC’s advice by saying: “Give patients who make a complaint about the care or treatment they have received a helpful response at the appropriate time.

“Respect the patient’s right to complain. Make sure that there is an effective complaints procedure where you work and follow it at all times. Co-operate with any formal inquiry into the treatment of a patient.”

Joanne Curran is associate editor of SoundBite.