Dr Annalene Weston, dentolegal adviser at Dental Protection, explores the role of communication and consent in handling complaints from patients

While the air may be still, and all may seem calm, under certain conditions when the barometer drops, a ‘perfect storm’ can occur. It cannot always be predicted and, while it cannot be prevented, there are steps that can be taken to mitigate its damage. Many complaints follow this identical path.

The ‘Swiss cheese’ model of accident causation can be used to illustrate the moment in time when all defences fail, and we realise to our horror that an issue has arisen; not due to one great error, but rather many small moments of failure, distraction and lapse - the cumulative effect of which can be severe. What, then, are the moments to look for?

First impressions count

Patients form a view about us, and decide whether they are prepared to enter into treatment with us very quickly. The saying “people don’t sue their friends” holds equally true for complaints and, consequently, building rapport with our patients through appropriate communication and active listening, to understand and address their expectations and concerns, is critical. Not only do our communication skills assist in developing this relationship, but also common courtesies – such as advising a patient if you are running late – can go a long way to ensuring patient satisfaction, reducing the likelihood of a complaint.

The conversation of consent is one of the most important conversations we have with any patient, and during this it is important to address not only what can go right with treatment, but also what can go wrong. It can be difficult to get the balance right, and presenting the required risks without scaremongering is a skill that can be learnt and developed.

Patient dissatisfaction or an adverse event may not be evident at the time of treatment, and may only be discovered at a later time, after the patient has left. An infection control breach is a good example of this. In the event of an infection control breach, we have a responsibility to be transparent and honest with patients about what has happened, and offer them an apology, explanation and, in some circumstances, blood borne virus testing and counselling. While it may be tempting to turn a blind eye to a breach and brush it under the carpet, we would urge you to contact Dental Protection if you become aware of a breach, to discuss what, if anything, needs to be said and done, and how best to achieve this.

If you did not write it down, it did not happen!

Sadly, this quip proves itself to be true time after time. Dental records remain the best way of evidencing what went on in the surgery on the day. What was discussed? What did you do? What didn’t you do, and why? Who was present in the room?

Reframe your perception of dental records as a vital component of quality patient care, not a tedious and time-consuming administrative irritation. Adverse outcomes can occur when the records can only be understood by the author – either because they are illegible, or contain abbreviated content, meaningful to the author, but not to others. Write your records as if you will not see that patient for the next appointment, signposting to a potential colleague following you what you had intended to do that day, as this is the surest way to ensure safe continuity of patient care.

Complete the loop

Do you keep getting the same complaint again and again? The only way to assess this is to audit your complaints and address repetitive themes. While this may seem to be a terrifying concept, recognition of things that may be happening in your practice that are prejudicing patients against you is paramount to addressing them.

The list is not exhaustive, as many factors can influence a patient’s perception of you, and promote or reduce the likelihood of a complaint. It is, however, a good starting point for a peaceful and pleasant practice.

Developing our communication skills not only serves us well in our budding therapeutic relationships, but can also assist us in breaking bad news to patients, and managing patient dissatisfaction and adverse outcomes. The Dental Protection workshop, Mastering Adverse Outcomes, can help in this area. You can also listen to our podcast series for further guidance and advice.