The stress of patient complaints
Lynne Clark looks at the latest statistics about the stress of patient complaints. She asks Farzeela Merali-Rupani for her advice on reducing the risk.
Ninety per cent of predominantly NHS dentists are anxious/very anxious about the risk of patient complaints.
That’s according to the latest Dentistry Confidence Monitor survey carried out over three months in 2019 and answered by more than 400 dentists. The figures also showed 59% of predominantly and totally private dentists were also anxious/very anxious about the risk of patient complaints.
Further to this, a BDA survey showed 43% of dentists can’t cope with the level of stress in their job. And the most common cause of this is patient complaints/litigation.
To find out more about how dentists can reduce the risk of patient complaints and what to do should you receive one, I spoke to Farzeela Merali-Rupani, a general dental practitioner and head of clinical at DD. She is experienced in dealing with fitness to practise concerns and patient complaints.
What are the common reasons for patient complaints?
Farzeela Merali-Rupani: I think a major cause of patient complaints is lack of communication. There is a huge amount of research to support this. 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 communicate this in an appropriate manner.
The very nature of dentistry means treatments will inevitably fail sometimes. This is due to a number of reasons. Some of which are within our control and some are not, such as 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% foolproof. There is a chance of fracture, discolouration, decay or other failures.
Just because a restoration fails, does not always mean the clinician did a bad job. A lot of the complaints I deal with highlight this lack of understanding as a major issue. 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 patient complaints to do with practice management issues. Once again, the majority of these boil down to poor communication before and even after the event. This can lead to further, sometimes unnecessary, escalation.
Is there anything dentists and their teams can do to prevent these kinds of complaints?
Farzeela: Follow the universal principles of good patient complaint handling, which were designed and developed by a number of organisations, including the General Dental Council (GDC), indemnity providers and the NHS.
Create an open environment within the practice so patients feel they can feed back 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 them to rectify the situation.
The biggest piece of advice I can give is to try to deal with things at a local level. If you deal with things locally, they hopefully won’t escalate to the external level. This way they won’t reach bodies such as the GDC, NHS and Dental Complaints Service. I have seen so many cases that have escalated beyond practice level, and become much bigger and more complicated as a result. So many could have been dealt with within the practice environment in a simple and easy manner.
If a practice does receive a patient complaint, what steps can they take to prevent it going any further?
Farzeela: As mentioned above, deal with things locally as soon as possible. Find out exactly what the patient wants and attempt to create an acceptable resolution. This doesn’t always mean giving them a refund, while this may be one solution, patients may also have other desires. So, find out what these are.
I cover a detailed step-by-step guide to dealing with patient complaints effectively at local level in my complaints handling webinars hosted by DD (bit.ly/2EcUWmx).
If a patient complaint does go beyond the practice, is there anything practices should/should not do?
Farzeela: Don’t panic! And don’t respond in haste. Contact your indemnity provider and discuss the details with them. They are the experts and can give you helpful advice. I would also recommend carrying out further learning and training in the areas that may have gone wrong, and reflecting on your practice, which ties in with your personal development plan (PDP) and enhanced continuing professional development requirements.
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 patient 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 move forward, learn from the incident(s) and to put in place actions to prevent the same situation from occurring again.
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 – it may surprise you to discover. Consider attending a hands-on course to refresh your knowledge and skills.
Showing 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.
Are there any practical things practices can do to reduce their anxiety around areas like patient complaints and litigation?
Farzeela: Keep good clinical records. I always recommend using the Faculty of General Dental Practice (UK) guidelines as a reference point. Your records make up a large part of your defence if patient 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.
To see the full results of the latest Dentistry Confidence Monitor survey, visit www.nhsdentistryinsights.co.uk.