Things you don’t want to hear from your patient

During a five-month treatment period, the following allegations were made by a female patient via letters of complaint:

  • “I kept pointing to the tooth causing the pain, but he wouldn’t believe me.”
  • “He was impatient with my continuing pain in the area.”
  • “I was administered six courses of antibiotics in five months.”
  • “A wisdom tooth was removed which still wasn’t the cause of the pain.”
  • “I lost six kilograms in weight (because of the pain).”
  • “His experience told him his treatment methods were infallible.”
  • “He was focused on methods, not me.”
  • “He was always in a hurry, and I was always aware of time constraints.”
  • “He was often on holidays.”
  • “His memory was vague on the treatment issues that affected me.”
  • “He didn’t take x-rays when I asked him to.”
  • “His nurse seemed to understand what I was saying, not him.”
  • “He was rude to me on occasions.”
  • “He refused to refer me to an endodontist, until he finally gave in and did so.”
  • “He said after the matter was resolved, he wouldn’t have done anything differently.”

Simply put, a lower first molar presented with pain. Conservative treatment yielded no improvement. The same quadrant third molar was removed by an oral surgeon. Endondontic treatment was initiated. The pain persisted, and swelling led to courses of antibiotics which were administered by more than one dentist in the practice (due to holiday leave absences) as well as a general medical practitioner. The patient was ultimately referred to an endodontist, who found the crack in the root. She was then referred to another oral surgeon for removal of the tooth. The pain disappeared.

The dentist has an answer for each of the above points made by the patient. However, the sheer number of complaints should make us pause and reflect on what was really said and heard, and consider that maybe some things were missed.

The first and foremost lesson to be learned from an experience like this is to ‘listen carefully to the patient’s history and description of their symptoms’. The patient is the only person who can provide the information we need to carry out treatment measures. After that, keep listening, because things can change, and we need to be flexible in our treatment modalities as signs and symptoms alter.

Secondly, the patient should be completely unaware of the external interests of the members of the practice, or of their holiday and other leave patterns. The major focus of the practice is the patient in the surgery at any given moment. Any other sojourn must be a side issue, and in the patient’s mind, very much subsidiary to their immediate treatment.

Importantly, not one of us are infallible. With the benefit of 20/20 hindsight, the crack in the root was almost a given and could have been detected if a little more attention had been placed during the initial appointment. We should never be tied-in to one line of treatment which excludes other possibilities of diagnosis or direction.

In addition, the patient’s perception of activities occurring outside the practice with the consequent disruption to scheduling is something hard to deny. It did happen and the patient was all too aware that their interests were not a top priority. No matter how much time is spent catering to immediate needs, if a patient feels the dentist is in a hurry, it’s the patient’s perception that counts, not the actual physical fact of time.

The fifth lesson is that the vagueness of memory of events leads us to wonder if the records are accurate. That is, not in the sense of the physical aspects of the day’s treatment, but in the diligent recording of the human side of events. Consider, ‘what were the patient’s symptoms at that particular instance, and were those issues adequately addressed?’

Furthermore, the nurse’s body language reinforced the patient’s perception that someone wasn’t listening.

In conclusion, this was not a situation that required much more than some explanation with abject apology on behalf of the dentist; for perceived lapses of concentration as described, and a refund of services towards ineffective endodontic treatment. Personalities come into every business relationship, and under the umbrella of pain, subjective issues have to be given more credence than they may otherwise deserve. As mentioned before, the dentist had a cast-iron objective explanation for all issues raised. However, to finish with the flourish that he wouldn’t have done anything differently raised the bar too high, leading to the patient’s complaint.

Key learnings:

  1. Listen carefully to the patient, not just when they are initially recounting their history or describing their symptoms but on an ongoing basis.
  2. Keep the external interests of the practice and its members private from patients.
  3. Do not tie yourself into one particular type of treatment and therefore exclude other options of diagnosis or direction.
  4. Do not appear hurried or appear to be in a hurry when attending to a patient – consider how your actions will be perceived by the patient.
  5. Ensure you that you record the human side of events not just the physical aspect ie. consider ‘what were the patient’s symptoms and were those issues addressed?’
  6. Apologise and admit if you have made an error. This may appease the patient and therefore resolve the situation before the patient lodges a complaint. At times, a refund may also be justified.

Dr Geoff Andrews
Community Relations Officer/Professional Consultant