The threat of complaints/litigation is the biggest source of stress to dentists, according to a recent survey by the BDA. More than 2,000 dentists responded to the survey and 54.9% said they were experiencing high job stress with the most common source (79%) being the threat of complaints/litigation.
These results also correspond with those of the most recent Confidence Monitor survey which found that 89% of NHS dentists and 63% of private dentists are anxious/very anxious about the risk of complaints. When it came to the risk of litigation, 91% of NHS dentists were anxious/very anxious compared to 65% of private dentists.
Clearly, this is a concern for the profession. To find out what dentists can do to stop a complaint from being taken further beyond the practice, I asked Farzeela Merali-Rupani, Head of Clinical at Dental Directory and a Clinical Case Examiner for the GDC: How can I handle a complaint to stop it from escalating?
Farzeela: ‘The majority of clinicians will always try their best to please patients and to achieve clinically acceptable results. Despite this, many are concerned about the risk of a complaint escalating beyond the local practice level.
This is understandable because as a profession we are held to high standards and we are also operating in an increasingly consumerist society and treating patients who are very well informed and have high expectations.
Research shows that a major cause of complaints is lack of communication. If patients do not fully understand something or a given situation, they are more likely to become frustrated and complain. It is our duty to provide them with as much information as possible to achieve this understanding and to communicate this in an appropriate manner.
The very nature of dentistry means that treatments will inevitably fail sometimes due to a number of reasons, some of which are within our control and some of which are not (e.g. patient-related factors). I think one of the issues we face is that some patients do not always understand that placing a restoration may not be 100% fool proof and that there is a chance of fracture, discolouration, decay, or other failures.
“The very nature of dentistry means that treatments will inevitably fail sometimes due to a number of reasons, some of which are within our control and some of which are not.”
Just because a restoration fails, this does not always mean that the clinician did a bad job. A lot of the complaints I see highlight this lack of understanding as a major issue, i.e. patients don’t seem fully aware of the pros and cons of treatments, including the risk of failure.
As well as clinical complaints, I often see many service-related complaints concerned with practice management issues. Once again, the majority of these boil down to poor communication before and even after the event which can lead to further, sometimes unnecessary, escalation.
To prevent escalation, it is wise to follow the Universal Principles of Good Complaint Handling (2018) which were designed and developed by a number of organisations, including the GDC, indemnity providers and the NHS.
Create an open environment within the practice so that patients feel they can feedback their concerns to you and suggest improvements before things get out of hand. Be honest with patients, when things go wrong, own up and admit to it. Then work with the patient(s) to rectify the situation.
The biggest piece of advice I can give is to try to deal with things at the local level, efficiently and effectively. If you deal with things locally, they hopefully won’t escalate to the external level and reach bodies such as the GDC, NHS, DCS. I have seen quite a few cases that have escalated beyond the practice level and become much bigger and more complicated as a result, when in fact they could have been dealt with within the practice environment in a simple and easy manner.
“The biggest piece of advice I can give is to try to deal with things at the local level, efficiently and effectively. If you deal with things locally, they hopefully won’t escalate to the external level and reach bodies such as the GDC, NHS, DCS.”
Another thing you can do to reduce the risk of complaints escalating is to keep good clinical records. I always recommend using the FGDP guidelines as a reference point. Your records make up a large part of your defence if complaints or litigation arises. Seek regular feedback from your patients either verbally or via patient surveys so that you can identify issues before they escalate.
Keep up to date with evidence-based guidelines and regulations – I know there are a lot! – but it’s part of our job as healthcare professionals and it’s within our GDC standards. Patients don’t expect us to know everything off by heart, for example, reciting multiple drug dosages from memory, however, as “experts” in the field of dentistry, they expect us to know where to go to find the relevant information they may require to aid their care.
If a complaint does go beyond the practice for some reason, the most important thing is to keep calm and don’t respond hastily. Contact your indemnity provider and discuss the details with them. I would also recommend carrying out further learning and training in the areas which may have gone wrong, and reflecting on your practice, which ties in with your PDP and eCPD requirements.
“If a complaint does go beyond the practice for some reason, the most important thing is to keep calm and don’t respond hastily.”
When external organisations begin reviewing the case as a whole, they will of course look into what happened in the past and what caused the complaint to occur, however, they also understand that things can go wrong and mistakes happen. We are all human! Therefore, they will also give weight to what you have done to rectify the situation, to learn from the incident(s) and to put in place actions to prevent the same situation from occurring again. Sometimes we learn the most from our mistakes.
For example, if a patient has complained about a poor standard of root canal treatment (RCT), then reflect on what went wrong and write this in your PDP. Discuss the situation with colleagues and maybe carry out a peer review. Think about auditing your other RCTs and their outcomes – you may be surprised by what you discover. Consider attending a hands-on course to refresh your knowledge and skills.
Showing that you can learn from and deal with an unfortunate situation puts you in a much better light to external bodies and signifies remorse and a level of professional insight which is expected of us as clinicians.’
Thanks to Farzeela for her expertise and advice in this very pertinent issue for the profession. Statistics from the GDC about the types of Fitness to Practice (FtP) cases they consider certainly does validate the idea that poor communication often has a big role to play in a complaint being made. Between 2014 and 2017, the number of cases due to poor communication rose from 5.4% to 8.2%.
Taking a step back to identify any areas where you could improve your communication with patients, and team members/colleagues could be a springboard for reducing the threat of complaints.