Leaving a sour taste in the mouth

Associate dentists leave their current practice for a variety of reasons,and occasionally this can be due to a breakdown in communication and issues surrounding working relationships within the practice. When an associate leaves a practice on bad terms this can be the catalyst for a number of unexpected patient complaints.This scenario can be distressing and difficult to manage if there is no agreement with the practice principal in relation to how to manage post-treatment issues that would otherwise be addressed by the dentist had they remained at the practice.

It is common practice for an agreed sum of money to be withheld by the principal for an agreed period of time when an associate leaves a practice, to allow minor problems to be resolved.

CASE STUDY

The relationship between a principal and an associate had deteriorated to such an extent that the associate left the practice.

The associate was clinically very competent and experienced, and had completed a number of challenging ‘tooth wear’ cases. One particular patient, Mr L, had been treated with composite build up restorations on numerous teeth to conservatively treat his tooth wear and the finished result was satisfactory. Whilst the associate’s clinical records reflected the merits and limitations of composite resin versus porcelain restorations, there was no mention that further charges would apply for the maintenance and/or repair of these restorations. When Mr L required some fairly minimal general polishing of the composite restorations due to surface staining, he said he had not been informed that additional charges would apply and did not expect the owner of the practice to charge him for this treatment.

Mr L resented being asked to pay for polishing the composites and raised the issue with the principal, who passed the complaint to his former associate. Although the associate had moved over 70 miles away, he offered to review the patient and provide the necessary treatment at no cost, but the patient was understandably unwilling to travel to take back.

This scenario was not an isolated example; it was a recurring story involving a number of patients who required similar maintenance work. Rather than completing this work as a gesture of goodwill to maintain the reputation of the practice, the principal encouraged every minor concern to develop into a complaint that required a formal response from the associate. The fact that the patients were being charged an over-inflated cost for treatment by the principal only added to their dissatisfaction.

The associate contacted Dental Protection,and with the benefit of hindsight, realised that he had not made it clear to Mr L – or to the other patients – that ongoing treatment would be chargeable. He recognised that there had been no clarity regarding what aspects of the treatment were covered by the original fee, and as a result, patients had unilaterally made some assumptions.

Dental Protection advised the associate to talk to the principal and to try and come to an agreement so as to avoid further incidents that could be harmful to both their reputations.

The associate and principal reached an agreement between them to cover the reasonable cost of post-treatment maintenance/polish appointments.

Learning points

• This case study illustrates the importance of maintaining professional relationships and taking the time to agree how patient care can, and should, be handed over when a dentist leaves a practice.
• Many practitioners find it helpful to have a signed agreement that includes a clause regarding the retention of fees for remedial work when an associate leaves a practice. This avoids disputes and disagreements that may arise after the departure of an associate.
• When planning treatment that requires ongoing maintenance, clear explanations should be given to the patient and documented in the record. This should include an explicit statement as to what the initial fee includes and what charges may apply in the future. This should be set out clearly in writing for the patient and a copy retained in the records, so everyone knows what to expect.
• Financial disputes between the principal and an associate should be resolved between the two parties and not involve the patient.