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For Private patients
• The Dental Complaints Service assists private dental patients and dental professionals resolve complaints about private dental services.
• An independent dental complaints service funded by the General Dental Council.
Dealing with difficult people in the clinic
• They may have a point!– But may not be
expressing it well!
• Angry • Nasty • Demanding • Critical • Oddball • Indecisive
• Sarcastic • Intoxicated • Shifty • Argumentative
No one has to tolerate abuse or bad language!!!
Common reasons for being difficult
• Tired, frustrated, frightened
• confused or overwhelmed
• defending their ego• unfamiliar with
situation• feel ignored• under influence of
drink or drugs
• don’t understand• in bad mood• in a hurry• other reasons…..
Why do complaints occur?
•Error•Unaware of costs involved•Poor understanding/poor explanation•Unrealistic expectations•Failure to appreciate needs/wishes of
patient
Handling complaints in the clinic
• Take aside• Listen• Repeat • Apologise • Acknowledge • Thank • Follow up
• Don’t take it personally
• Remain calm • Focus on the
problem & not the person
• Try and turn the situation into a better one!
How to answer a complaint letter
Look at the complaint letter, clinical notes and response.
Acknowledge receipt & deal with promptly
1. Consider how you would answer it?2. What do you think of the response?3. How could it be improved?
Response• Aim
– Resolve concerns– Not about who’s right and who’s wrong
• Factual content– Chronology– Findings– Actions– Reasoning– Correct
• Tone– Non-confrontational– Sympathetic– Non-defensive
• Answer questions raised
Bolam vs Friern Hospital Management Committee[1957]
“A doctor is not guilty of negligence if he has acted in accordance with a practice accepted as proper by a responsible body of medical men skilled in that particular art
…a doctor is not negligent if he is acting in accordance with such a practice, merely because there is a body of opinion taking a contrary view.”
McNair, J
Breach of duty- Bolitho
Bolitho vs City and Hackney Health Authority[1997]
“If in a rare case it can be demonstrated that the professional opinion is not capable of withstanding logical analysis, the judge is entitled to hold that the body of opinion is not reasonable or responsible”
Clinical Guidelines
“If guidelines have been produced by a respected body and have been accepted by a large part of the
profession, a doctor would have to have strong reasons for not following
that guidance”
Causation
The claimant must prove that the breach of duty caused or
substantially contributed to the damage suffered.
Foreseeability
• The injury caused must have been foreseeable.
• “Reasonable anticipation”• E.g.
– Not taking an adequate medical history– Not using rubber dam
Concurrent negligence by the patient and the doctor, resulting in delayed recovery or harm to the patient.
Defence for the doctor in civil cases.
Burden of proof on doctor.
Contributory negligence
Liability of the master (employer) inspite of absence of blame worthy conduct on his part.
Negligence
Employer responsible for negligent acts of his servants.
Within the scope of his employment/range of services.
Tort of occupier’s liability (e.g. visitor injured on practice grounds).
Vicarious liability
Quantification of Loss• Compensation
- General Damages = Pain Suffering and Loss of Amenity- Special Damages = Actual loss until date of trial.- Future Loss = Predicted future loss- Bereavement award
Time Limits
• Limitation Act 1980
• 3 years– Date of
knowledge– Children– Mental Disability
For NHS cases normally limit of 1 year applies
Areas for Good Practice
• Communication• Prescribing• Medical records• Training• Equipment• Guidelines/Professional
responsibilities
Communication Skills
• Most complainants and claimants mention communication as a problem
• Most health professionals think they communicate effectively
• Be especially clear when discussing fees/costs – NHS/private
Competence
• Always act within your limitations• Never undertake a task that is
beyond your competence
Chaperone
• Applies whether or not you are the same gender
Confidentiality
• 1998 Data Protection Act • GDC guidance (Confidentiality:
Protecting and providing information)• Take steps to avoid potential leaks
– Reception areas – overhearing sensitive info
– Restricted access to electronic records to only those who require it
– Encryption software
Consent
• GDC guidance• Capacity• Always obtaining consent – even for
the briefest of physical examinations!
• Civil claim in negligence/ assault
For “Valid” Consent
• Competence & Capacity • Voluntariness • Knowledge
“A dentist must explain to the patient the treatment proposed, the risks
involved and the alternative treatments and ensure that
appropriate consent is obtained”
GDC ethical guidance to dentists in relation to consent
“Informed” Consent
• Implied, verbal or written consent
• Type depends on risks of treatment
considered!• Children –
“Gillick”
Clinical Records
• “You must keep clear, accurate and legible records, reporting the relevant clinical findings, the decision made, information given to the patient, and any drugs prescribed or other investigation or treatment” GMC
• Never rewrite notes at later date – make clear any retrospective entries by signing and dating alterations
• Patients have legal right to access their records• Avoid derogatory statements, offensive patient
acronyms and criticism of colleagues!
Careful prescribing
• 25% of NHS claims from prescribing errors• Generic drug names• In accordance with BNF• Commonest errors
– Wrong dosage– Inappropriate medication– Failure to monitor treatment (SEs and toxicity)– Communication failure
Conduct
• 20% of all complaints about GPs were in response to poor attitude
• Calm, sympathetic and professional manner
• ‘Physician-Patient Communication’ – Drs who never received a claim used humour and laughed more and spent approx 3 min longer per consultation
Cover
• Check with your medical protection organisation for appropriate cover to reflect the work you do
Communication
• 43% of complaints to Healthcare Commission were related to limited discussion about treatment options
A dental professionals role in detecting systemic disease
• Asses head & neck• Exclude a dental cause• Referral as required • Give appropriate health
advice• Health assessment as
per training i.e. for sedation etc.
Cover your back
• Seek advice from senior colleagues or your medical protection organisation
• Respond promptly
• What % risk of a complication happening do you discuss with your patient?– Depends on severity/consequences if it
happens!
Cutaneous sinus tracts of dental origin….
• Are often misdiagnosed and inappropriately treated because of their uncommon occurrence and the absence of symptoms in ~ 50% of the individuals affected.
• Often referred with a recurrent or chronic cyst, a furuncle, or an ulcer on the face or neck.
• Correct diagnosis is based on a high index of suspicion and on radiological evidence of periapical pathology.
• Appropriate treatment usually results in predictable and rapid healing of these lesions
Take home messages
• Common things are common but rare things do exist!
• Quality of your radiography!• Tunnel vision• Review when things not happening
as expected• Get further opinion(s)
Things go wrong - What to do!Summary
• Keep good contempory records– & Keep the records!
• Be honest – – say sorry!, offer money back & put right at
your expense• Offer referral for a second opinion• Good communication skills are essential• Don’t inadvertently become an “expert
witness” against a colleague• Liaise with your defence society
– And follow their advice!