A patient had attended a practice on three previous occasions, seeing a different dentist at each appointment. He attended the first dentist with a fractured filling at tooth 36, which had been placed many years earlier at another practice. The dentist placed a temporary dressing and advised that the patient return for a check-up and filling appointment.
At the second appointment, the patient saw the practice owner, who carried out an examination and placed an amalgam DO filling at 36. The dentist also diagnosed the early stages of periodontal disease and recommended a course of periodontal treatment. Non-surgical root surface debridement was completed over two visits and it was advised that the patient return for a three-month follow-up appointment.
The patient did not attend for the follow-up but returned one year later, requesting a scale and polish to remove stains that had built up on the teeth as he had a family function that he would be attending the following week. The patient was advised on the phone by the receptionist that he was due for a check-up, and asked whether he would like to book for his gum care at the same time. The patient booked in for the treatment as advised and at the appointment he mentioned that he had experienced some food packing in the region of 36, where the previous filling had been placed. A clinical examination identified that the filling was stable, but the patient was given the options of either smoothing the filling interproximally or replacing it to see if the contact point could be improved. As the filling had been placed more than one year earlier, a new charge would apply for a replacement filling.
The gum care was completed, but the patient expressed dissatisfaction at the time as not all of the stains had been removed. It was explained that if he wanted a full stain removal for cosmetic reasons, an additional hygiene appointment would be necessary.
The patient left and the following week a complaint by email was received. The patient was unhappy that not all of the stains had been removed and explained that this was the prime reason for the appointment. He was also not happy that he was going to be charged for a replacement filling when the dentist had identified that there was a problem with it.
Both dentists involved were members of Dental Protection, and they sought our advice. An explanatory letter was sent and the patient was offered a refund of the charge that he had paid for the examination and for the gum care. The patient responded requesting a refund of the filling placed one year earlier at tooth 36, and asked for compensation of R1000 towards his next gum care appointment.
A decision was made to offer the patient a refund of the fees for the filling, as a gesture of goodwill and in an attempt to resolve the complaint swiftly and amicably. It was, however, decided that the offer of R1000 towards a hygiene appointment in addition to the refund would have been considered to be betterment, and so this was not offered.
The patient accepted the refund and the complaint was satisfactorily resolved.
Learning points
This case raises the question of what to do when a patient asks for ‘compensation’. The term has a different meaning legally than in common use, and whether it means the case should really be considered in the formal sense of the word as a request for damages arising out of negligent care or more simply for some level of financial remedy where service failure has arisen. Situations like this often arise when a patient writes a letter of complaint to a dentist and mentions that they would like financial compensation. A decision needs to be made as to whether the patient is indeed acting as a Litigant in Person, seeking compensation for pain, suffering and loss of amenity (PSLA) or whether the complaint can be managed in line with the practice complaints handling policy, with the offer of a refund of fees or assistance with remedial treatment costs.