By H. Candace DeLapp, D.D.S., Executive Director, Dentists Professional Liability Trust of Colorado
From the Spring 2021 Journal of the Colorado Dental Association
Anger by a patient is often the nidus for a patient leaving a practice, making a demand, filing a Colorado Dental Board Complaint or even litigation. Interestingly, it is not always because of the quality of care provided but the perceived lack of caring, concern, inattention, or hostility by the dentist and/or the dental team. When a provider is unwilling or unavailable, these non-dental factors may greatly contribute to a breakdown of rapport and an escalation of a patient situation. Let’s review a few of these pitfalls.
“Pave your way with words…” I still remember my dental school professor saying this over and over again. Patients often have unrealistic expectations in regard to treatment outcome, treatment time and treatment cost. The patient who feels that your treatment will undo years of dental neglect, unhealthy habits (such as smoking) and poor compliance may experience disappointment when the result is compromised. A consultation with a well written informed consent provides information so the patient may decide whether to proceed with treatment or elect no treatment. It is a method to manage expectations, create patient autonomy, and therefore reduce the malpractice gap.
“How long is this gonna take doc?” A patient understanding treatment time is important. Give the patient an idea of how long it’s going to take. You’re extracting teeth and placing implants for the final prosthesis. Is this a single tooth replacement or is it an implant retained full arch rehabilitation? Is bone grafting and tissue management involved? Will it be immediately loaded, take one month, one year, or longer? What will the patient have in the interim for temporary dentition? Try to get your patient’s expectations and your ability to deliver on the same level or as close as you are comfortable with. By managing predicted timelines in the beginning, you manage the patient’s expectations and avoid the perception that “something is wrong.” Under promise and over deliver!
“How much will this cost?” If your office accepts insurance or is fee-for-service, producing accurate estimates is one of the most important aspects and keys to successful practice management. Why? Patients will hold you to it, even when they say they won’t. They don’t want to get in over their head or feel like they got “ripped off,” and you don’t want to have to try to collect unpaid balances. Since there is no such thing as the “perfect estimate,” what the patient really wants to understand is “what is the whole thing going to cost?” Does the patient have a budget? Do you have enough information to give an estimate of what insurance would pay? Would the patient do the treatment even if insurance paid nothing? Maybe outside financing would help the patient achieve their dental goals. Enter the written, signed Financial Agreement. Having a clear agreement as to the costs and how and when they will be paid mitigates the risks and fears for the patient getting in over their head and the practitioner becoming the banker.
“One of my biggest pet peeves is when a contractor comes to my house and announces the previous contractor didn’t know what he/she was doing (implying they know better or can do better),” Dr. Naren Rajan posted on social media. Disparaging, uninformed, or careless remarks by one dentist about another dentist without knowing all the facts may be the basis for a claim. The patient’s side of the story may be all you have, but there is usually another side. Take time to reach out to the previous provider. Find out the whole story. Remember, remarks about previous treatment will not fix the problem and you may find that you are unable to achieve that perfection the patient demands.
Finally, when a patient becomes disenchanted, take the time to have a face-to-face discussion, preferably during non-patient contact hours. Let the patient have their say, respectfully, of course. Listen to their concerns. Most of the time you and the patient will be able to reach a mutually beneficial course going forward. Invest in the time to communicate! An attorney put it this way, “It’s the providers who lack ‘people skills’ that find themselves in trouble.”
Take an opportunity to assess your communication skills and protocols. Make changes to bring your patient care to a more comfortable level for you, your team members, and your patients! You will find informed consent forms and other resources to assist your communications and risk management on the The Dentists Professional Liability Trust’s website at tdplt.com (under “Resources”).
Candace DeLapp, D.D.S., is the executive director of the Dentists Professional Liability Trust of Colorado. Contact her at hdelapp@berkleyrisk.com.