Official complaints about dentists to APHRA are on the rise, but industry experts agree it’s how you respond, rather than react, that can make all the difference. By John Burfitt
Meet the man who handles complaints against dentists.
In his role as the Australian Dental Association’s NSW Advisory Services manager, Phil Breen regularly deals with patients who feel they have a valid case of wrongdoing by their practitioner.
Yet while he talks about the legitimate and valid cases he has processed, Breen also tells about the ones that have been vexatious. One of the more memorable—and extreme—is a case, he says, that offers an insight into the lengths some patients will go to.
“One person went to the dentist complaining that their denture didn’t fit, and while the dentist attempted to fix the problem, the patient kept complaining and threatened to make an official complaint. The dentist eventually gave a full refund,” Breen recalls.
“Then, three more people from that person’s local club turned up and after being treated, began complaining about the same thing, until the dentist worked out what was going on.”
Ask any dentist who has ever received a patient complaint—either directly or through a notification from one of the various national or state regulatory bodies—and they’ll tell you the experience was no laughing matter.
Moreover, this is a situation an increasing number of dentists are facing. Registered dental practitioners with APHRA (Australian Health Practitioner Regulation Agency) notifications comprised almost 10 per cent of the total number of notifications issued in 2015-16, even though registered dental practitioners constitute only 3.3 per cent of all registered health practitioners
More significantly, this marked a one-year rise to 34 per cent—that is, 1,025 notifications compared to 766 in 2014-15.
The main notifications appear to run the gamut from practitioner personality issues and conduct concerns, through to clinical performance and financial matters.
Other issues involve miscommunication, when patients did not understand what a treatment would involve, possible outcomes and potential risks.
“It’s part of practising dentistry today that you’re probably going to have a complaint—or even complaints—made against you in your career,” Breen adds.
“The key message to remember is not what is happening to you, but how you manage it. This is something you need to respond to rather than react to—and that can be hard as this is a very emotional experience.”
Breen estimates that of all the cases referred to the Health Care Complaints Commission, as many as 70 per cent are found to have no case to answer. But he adds these figures are not comprehensive, as many complaints are dealt with directly between the patient and dentist, or through lawyers.
“We shouldn’t run from complaints; while undeniably upsetting to receive, a complaint should be viewed as an opportunity to put things right and the patient simply voicing their concerns in the hope of getting some sort of resolution.”—Dr Alex Holden, lecturer, University of Sydney
In all cases of a dental practitioner facing a complaint, however, Breen advises the best course of action is to seek advice through the state branch of the ADA.
“Without exception, that’s the first thing any dentist should do,” Breen says. “Whether the complaint has been made direct to the dentist or through a regulatory body, professional advice should be sought first.”
Some believe that dealing with a situation directly and effectively before it is taken to higher authorities is the best approach. Dr Alex Holden is a lecturer in Dental Ethics, Law and Professionalism at the University of Sydney’s Faculty of Dentistry, and says in an age where feedback is encouraged, dentists need to be prepared to deal with all levels of patient comments and criticism.
“A complaint made initially at a local level should be welcomed and seen for what it is—the opportunity to put something right,” Dr Holden says. “We shouldn’t run from complaints; while undeniably upsetting to receive, a complaint should be viewed as an opportunity to put things right and the patient simply voicing their concerns in the hope of getting some sort of resolution.”
It’s a point consultant Julie Parker of Melbourne’s Julie Parker Practice Success agrees with. Having advised several dentists who have faced such an issue, Parker says acting immediately is the best approach.
“This is never something to sit back and just hope it goes away—you need to take it seriously, act on it and deal with it head on,” she says.
“Offer to give the patient a full refund and a referral to a specialist who is more qualified than you to complete that treatment. You need to be seen to be doing everything you can so the patient is getting—at the very least—back to where they were before they saw you, and never leaving them worse off for having seen you.”
Parker believes adopting such an approach can avoid a protracted fight that can easily get out of control. “You can fight this all the way along and take a year of trauma, and end up with the same result. Look at the broader picture of what’s going on. If you must refund $3000, it might work out to be a small percentage of your annual turnover—and that’s tough, but you might have to acknowledge you just can’t win them all.”
One of the most important aspects of being prepared to deal with any complaint is ensuring all records and notes are kept in detailed order.
Former ADA CEO Robert Boyd-Boland, who also works as a lawyer, advises it’s paramount for a practitioner to keep thorough and detailed patient notes, claiming it can make the difference between a complaint notification that is dismissed and one that’s pursued.
“It’s often not because the patient has better evidence, but that the dentist can’t disprove the patient’s claims because their records are inadequate,” Boyd-Boland explains.
“Without notes, there’s nothing to confirm what you spoke about, the decision-making process with the patient and what you said and did. So, you’ve really got no defence.” He then offers this often-quoted adage, “Good records, good defence. No records, no defence.”
If the number of complaint notifications a dentist or practice receives becomes a regular issue, however, Julie Parker says it’s time to take a tough look at what is really going on within a clinic.
“You might need to look at what has gone wrong with the service that you are providing, or at the practice as a whole,” she says. “I like to think what you’re selling as a dentist is patient satisfaction, but if you have a repeat pattern that they are not satisfied to the point they’re making complaint notifications to APHRA, then it’s time to not only know how to deal with the unhappy patients but also your processes that have clearly become an issue.”