Complaints

1. Complaints

2. 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.

3. They may have a point! But may not be expressing it well! Angry Nasty Demanding Critical Oddball Indecisive Sarcastic Intoxicated Shifty Argumentative Dealing with difficult people in the clinic No one has to tolerate abuse or bad language!!!

4. 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….. Common reasons for being difficult

5. Why do complaints occur? • Error • Unaware of costs involved • Poor understanding/poor explanation • Unrealistic expectations • Failure to appreciate needs/wishes of patient

6. 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! Handling complaints in the clinic

7. How to answer a complaint letter Look at the complaint letter, clinical notes and response. Acknowledge receipt & deal with promptly • Consider how you would answer it? • What do you think of the response? • How could it be improved?

8. 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

9. Clinical Negligence

10. Clinical Negligence Claimant must show • Duty of care • Breach of duty • Causation

11. Breach of duty • Bolam test • Guidelines and protocols

12. “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 Bolam vs Friern Hospital Management Committee[1957]

13. 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”

14. 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”

15. Causation The claimant must prove that the breach of duty caused or substantially contributed to the damage suffered.

16. Foreseeability • The injury caused must have been foreseeable. • “Reasonable anticipation” • E.g. • Not taking an adequate medical history • Not using rubber dam

17. Contributory negligence • 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.

18. Vicarious liability • 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).

19. 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

20. Time Limits • Limitation Act 1980 • 3 years • Date of knowledge • Children • Mental Disability For NHS cases normally limit of 1 year applies

21. How to avoid troublesimple answeryou won’t!

22. Areas for Good Practice • Communication • Prescribing • Medical records • Training • Equipment • Guidelines/Professional responsibilities

23. 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

24. 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

25. 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

26. Consent • GDC guidance • Capacity • Always obtaining consent – even for the briefest of physical examinations! • Civil claim in negligence/ assault

27. 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

28. “Informed” Consent • Implied, verbal or written consent • Type depends on risks of treatment considered! • Children – “Gillick”

29. 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!

30. 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

31. 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

32. 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

33. 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.

34. 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!

35. 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

36. 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)

37. 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!

38. Finally……. Accidents & misdiagnoses happen & are not necessarily negligence! Its what you do and say that counts! Saying sorry doesn’t necessarily equate to admitting liability!