How To Respond To A Patient Complaint Against A Dentist - Page 3

Our approach to patient complaints is to take every step necessary to put an effective defence forward, from the outset. Typically, we follow the following steps in responding to a patient complaint:

1) The dentist must prepare a response, in her own words, to the issues raised in the complaint;

2) The dentist must transcribe all handwritten chart entries so that they are easily legible for the lawyer, and the RCDS;

3) If any other staff members or dentists in the practice have information with respect to the complaint, those witnesses will be interviewed. For example, a dental hygienist or dental assistant may recall the informed consent discussion before a patient agreed to have a root canal. The receptionist may recall a patient yelling loudly at the dentist, or swearing or acting inappropriately;

4) We consider whether an expert opinion would assist the dentist. It may strike dentists as unusual that an expert opinion would be considered at the Complaints Committee level. However if the complaint is serious enough, the provision of a timely expert opinion may defuse the complaint at an early stage; and

5) It may be necessary for us to request other records from the RCDS. An x-ray may be in the possession of another dentist. The RCDS typically collects patient records from all prior and subsequent treating practitioners. We are very careful to review all records to see if there is any assistance to be rendered to the dentist, by the contents of those records.

6) As indicated above, we are now recommending to our dentist clients who have made mistakes that are identified in patient complaints to be proactive and address those mistakes by taking a course or courses well before the ICRC makes a decision. In this way the dentist can lessen the possibility that courses will be ordered that will be publicly disclosed. This requires the lawyer and the dentist to agree together on issues where it is clear that the dentist has made mistakes.

Do you really need a lawyer to respond to a patient complaint?

Dentists routinely regularly respond to patient complaints without the benefit of legal advice. Dentists are able to have complaints against them dismissed without the benefit of legal assistance. However, given the significant negative consequences of an adverse complaint decision, it is always the best advice for you to obtain legal advice. Litigation lawyers are trained to identify issues of concern, and in assisting clients to express themselves succinctly and effectively. Defending a dental complaint is initially based on written advocacy, explaining the dentist’s position. As advocates, lawyers should be able to write efficiently and focus on the appropriate issues. Not all lawyers will have sufficient familiarity with issues of professional misconduct and dentistry in order to render the specific expert assistance required to effectively deal with these matters. You would be well advised to retain a lawyer who has acted for dentists before, and has knowledge of both the complaints process and dentistry, then you will be much better served by retaining that lawyer.

Most importantly, lawyers provide an objective opinion with respect to the merits of a complaint. I am routinely obliged to tell dentists that their regulator will find that they acted inappropriately, or that they committed professional misconduct. It is sometimes necessary to hear this perspective from an objective third party in order to make the best of a bad situation. There is no tactical benefit to taking a position that is destined to be rejected by the Complaints Committee.

Appropriate tone and language

It is essential that the dentist’s written complaint response be written in a respectful and professional tone. There is nothing worse than a dentist who writes a letter that insults the patient. If a patient complains that a dentist was rude and aggressive, then it certainly doesn’t help the dentist’s cause to write a letter that is rude and aggressive as well. There is nothing to be gained by insulting the patient or the patient’s intelligence. As part of the process your response will be given to the patient/complainant to comment upon.

There is a way to subtly communicate to the Complaints Committee that a patient is an unpleasant individual, without stating this directly or by being insulting. From time to time I have acted for dentists who have been the subject of a complaint by a patient who has mental health issues. There are also ways to communicate this information without being seen as being insulting or demeaning to the patient. For example, at the start of most dentist’s complaint response letters, we recommend providing a summary of the relevant dental history, and medical history. Information about patient’s mental health or medications can be referenced in this section.

Importance of responding to all issues

Patients may write disorganized and rambling letters. It is important that the dentist appreciate all of the relevant issues that are raised. A typical issue that dentists may miss is the issue of informed consent. Patients may complain that they did not understand that when they had a large restoration performed, that it might increase the risk of requiring a root canal on that tooth. This directly raises the issue of whether an informed consent was obtained. The patient will not mention the concept of informed consent, although the ICRC will address this issue. Patients will also not complain that the dentist’s records are deficient or that the dentist failed to follow the Anaesthesia Guidelines. However, an experienced lawyer should know that these issues will be directly at issue, and considered by the RCDS, and help you respond accordingly.

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