Business of Dentistry

Learning from Complaints

Complaints are a hot topic for the NHS at the moment, are increasing in number year on year as our society becomes more demanding and litigious. As clinicians we always try our best, sometimes in difficult circumstances, which perhaps were ought to record more fully in our notes. It follows that complaints can hit us quite hard. They are a fact of life in modern dentistry, and as such we need to have a plan to deal with them. I should like you to consider the following scenario.

You have worked hard to complete your patients’ treatments, which included fitting a crown on the last working day before going on holiday for 2 weeks well earned rest. When you return there is a letter to you marked ‘personal’. It reads:

This is not what you expected. This complaint is quite threatening with the ‘or else’ and raises several issues about your practice and clinical techniques.

1. The first move is to acknowledge receipt immediately by first class letter post. If the date of the complaint is more than 7 days old, explain that you have been on leave and have responded on your first day back at work. Offer to reply fully in 30 calendar days and   enclose a copy of the practice complaints procedure. If you haven’t got one – get writing NOW.
2. There are clinical issues so contact your Protection Society immediately for their advice. They will help you write the formal letter of response. This may be a holding letter pending further investigations and a request for a copy of both the notes from the emergency dentist and a copy of any monies claimed with receipts. Then always take your Societies advice. They are experts in these matters.

This complaint tells you your practice isn’t working effectively or efficiently. There is much to investigate and change.

Are you always running late?

If so, why? Is it receptionists fitting in too many patients? Are receptionist deciding how long you should be ‘allowed’ to spend on each procedure. This can often happen to Associate and Assistant dentist where a far more experienced principles expects more junior colleagues to work to their speeds. Are you not allowing enough time for each procedure. Do you know how long you really take? All these questions can be answered by carrying out an audit of the time you spend on each proceedure, how late you are running at both start and finish of the appointment and this should give you the necessary data to implement positive change. Computerised appointment books should allow easy data collection for say a week.

Are you relying on the tooth movements proposed by Dahl to correct occlusions that you ought to be balancing at the chairside?

They key question is does this philosophy of dental care really work for you? It never did for me both on the giving and receiving end of dental treatment and I abandoned the method as lacking exactitude and relying too much on a benevolent nature. How many patients are returning for further occlusal adjustments after crown and bridge fitting? How much time are you really wasting? I refer you back to the tips I gave in Model Practice and The ‘T’ Stop. The above factors are easily audited, and again the results may surprise you.

Why was the laboratory work not available on time?

This is a completely preventable problem if you book work into the laboratory before booking crown preparation appointments so that your technician has plenty of time to concentrate on your work. Exceptionally, if your technician is ill, everyone will understand a one-off occurrence. Has the post failed? Again I explored at length in ‘A cunning little plan’ using guaranteed next day delivery postal services. More expensive yes, but remember what your time is really worth. This postal method very rarely failed to deliver, usually when the country was at a snowbound standstill. Look again at the time of day you fit your crowns.

Why are your temporary crowns becoming loose before the fit appointment? This is an issue with your clinical technique and the materials you are using. Are you spending too little time on this aspect of crowning teeth. I recommend that following the preparation you make the temporaries next before impression taking. Then having got that sometimes unpleasant stage over, you and your patient are on the last stretch.

I have received complaints too. Mrs A’s periodontitis had not been controlled despite 3 monthly hygienist visits. Interproximal plaque control was poor. She used one size of brush, despite varying size spaces, because ‘she wouldn’t remember anything else’. My advice was use correct size brushes for each space. I gave an intra-oral demonstration. Complaint 1 –‘ why wasn’t I told this earlier?’

The next visit, complaint 2 – ‘I can’t remember which size to use where’. I drew a little diagram of spaces and teeth and wrote in which colour to use where.

The next visit, complaint 3 ‘this diagram is no good, it’s the wrong way round’. Of course, my diagram had shown her right side on the left side of the page. For her to follow with the sheet in front of a bathroom mirror, it had to have right side on the right side of the page.

This patient revelation led me to develop the Spacemark Dental computerised system of interspace charting. Check which size brush is correct, click on the space on the chart, then the colour, which the programme inserts, and so on around the mouth. Once saved, the view is changed 180 degrees for patients, printed out, and given to them (see: www.spacemark-d.com).

In summary, not all complaints are a bad thing. Take time, audit the problem areas and you and your staff can learn a great deal from them. When you implement changes following a complaint, always thank your patient for drawing the problem to your attention and explain what you have done to put the matter right. Remember too, that sorry is a very important word in the context of complaints and can go a very long way to resolving matters amicably.