Guild Insurance regularly analyses claims information to understand factors which may contribute to claims and complaints occurring.  This analysis has highlighted a trend where claims involve treatment by at least two dentists.

Evaluating another dentist’s work

All dentists will at times treat a patient who’s had dental work carried out by another practitioner.  And you may have questions about that treatment, such as when:

  • the work may not seem to be up to the standard expected of a registered dentist;
  • the treatment selected may not appear the be the ideal or obvious choice given the clinical situation or
  • it may seem as though the treatment provided has not led to the intended or expected outcome

Dentists must be very mindful of how they handle these situations and what they say to or in front of the patient.  It’s understandable that to provide treatment the dentist will want a complete understanding of prior treatment.  However conversations about another practitioner’s treatment, if not conducted appropriately, may contribute to the patient lodging a complaint against that other dentist.

What can go wrong?

Not all situations where a dentist questions previous treatment will lead to issues arising.  However the following case examples highlight how easily complaints can occur.

A patient had received many years of dental treatment from Dentist A.  Whilst happy with the treatment provided, the patient began seeing Dentist B when she moved house.  During a consultation, Dentist B commented on the file fragments which had been left in her tooth, assuming she was aware.  When she appeared surprised, Dentist B explained that he had detected small fragments of a file which had been left in a tooth following RCT.  Dentist B was openly critical of Dentist A for what he described as ‘sloppy treatment’ and told the patient she should have been informed at the time when the file broke.

Whilst away for a weekend, a patient felt a tooth break whilst eating.  He decided to see a local dentist who was available to provide emergency treatment.  When he returned home he went to see his regular dentist to receive further treatment to that tooth.  His regular dentist was quite surprised with and critical of the treatment provided by the other dentist.  She informed the patient that due to the poor work she was going to have to replace what was done, therefore costing the patient more than he had anticipated.
 

Impact of comments made

Making negative comments about the work of another dentist can reflect poorly not just on that dentist but the profession as a whole.  If the entire situation surrounding treatment is not understood, the comments may be incorrect and presumptuous.  This can unfairly damage the reputation of a dentist as well as cause unnecessary frustration for the patient.

It’s therefore very important that when a dentist finds themself in a situation where they have questions about the work of another dentist, this is handled appropriately.

Tips for managing these situations

  • Don’t make off the cuff comments to a patient judging or criticising the treatment another dentist has provided. Making even what you see as a small or insignificant comment to a patient regarding the choice and quality of treatment provided by another practitioner could be enough to encourage that patient to make a complaint or a demand for compensation.
  • If your patient has received treatment which doesn’t appear to have been the most preferred for their clinical situation, don’t assume this is an error on the part of another dentist. Sometimes patients choose a different course of treatment to that recommended by their dentist, often due to financial restraints.
  • If you have concerns or questions about the treatment your patient has received from another dentist, consider seeking the patient’s permission to contact that dentist to find out more about the treatment provided and reasons behind their clinical decision making. It’s possible that the clinical situation you’re seeing is not exactly the same as the first dentist saw.  Avoid making assumptions.
  • When sending a patient back to their referring practitioner, provide a letter for that practitioner outlining your diagnosis, the treatment you provided and why that treatment option was selected. Don’t rely on the patient to convey this information.
  • Documentation is vital! If your work is being questioned by a patient, another dentist or AHPRA, you’ll need your accurate clinical record to act as the explanation and evidence behind your clinical decision making.
  • Patients can become frustrated with ongoing treatment costs. If replacement work is required, be very clear and upfront about the cost of this further treatment.
  • Avoid offering free or discounted treatment when replacing work. This may further suggest that the initial treatment was ineffective and therefore a waste of money.  Also the patient may expect that discounted or free treatment will continue beyond what you had anticipated.  Always contact your local ADA branch or Guild Insurance before offering any form of discounted treatment to a patient.
  • And finally, maintain a high level of professional behaviour at all times, both when treating patients and also anytime you’re communicating and interacting with them. This not only reflects well on you, it can also improve the public perception of dentistry as a profession.