Case one
Mrs B was an oral health therapist working in a private practice. Mr G was a new patient and attended for an emergency appointment. Mr G was a particularly anxious patient, and this was compounded by the fact he was attending for an acute issue, about which he was very concerned. Regretfully, the appointment did not go to plan and Mr G left the clinic highly agitated and without any treatment having been performed. Almost immediately a flamboyant and detailed negative review appeared on the practice social media page, outlining Mr G’s heightened point of view and with cutting reference to Mrs B’s chairside manner.
Understandably Mrs B was horrified when this review was passed to her from the practice manager, as she did not believe it was representative of how things had unfolded; she was particularly upset that she had been named publicly. The practice reached out to Mr G in the first instance to discuss his concerns. Unfortunately, Mr G was not interested in discussing the matter further or amending his review.
On consideration of the options available, Mrs B remained very concerned about how the review may impact her professionally and chose to engage a solicitor to contact Mr G with a cease-and-desist letter regarding the review. No response was received, with no movement on the matter until the following month, when a notification was received from the Office of the Health Ombudsman containing a complaint from Mr G regarding Mrs B’s conduct. Interestingly, this notification was made on the same day the solicitors’ email correspondence was emailed.
Case two
Dr L was a general dentist and practice owner with a loyal patient base of families, which he had established over many years in the area. Mr R was a relatively new patient at the practice and Dr L had been working through an extensive treatment plan over the previous six months. The final phase of treatment included placing a crown on Mr R’s lower right first molar, followed by regular examinations and preventative hygiene appointments. Unfortunately, a complication arose during the crown insertion appointment, as Mr R suffered a significant laceration to his lower lip. Dr L administered appropriate first aid and immediately referred to an oral and maxillofacial surgeon for assessment and management.
Understandably Mr R was upset by this complication and approached Dr L over his concerns and the costs incurred for this specialist treatment. Additionally, Mr R felt that it was reasonable that Dr L did not finalise his account from the crown, until a resolution had been reached regarding his concerns over the specialist treatment costs. Dr L did not share this view and consequently, and prior to the finalisation of an agreement on the specialist fees, Dr L escalated the unpaid crown account to his normal debt collection agency for follow up as was standard practice protocol.
Mr R viewed this not as a separate issue, but rather an escalation and an indication of the deterioration of their relationship. He decided that as their ability to communicate directly had broken down, this matter was better mediated by a neutral party and he lodged a notification to the Health Consumer Complaints Commission. Once local resolution was completed regarding the financial aspect of Mr R’s concerns, the matter was then referred to the Dental Council for investigation of the clinical components.
The Tipping Point
In both of these situations, the practitioners involved elected to follow established practice protocols as a way of following up the patient. Regretfully however, in these specific circumstances with those specific patients, the more aggressive strategies adopted added fuel to the fire.
In case one, what may have died a natural death of a historical bad review buried under future positive reviews, resulted instead in a full-blown investigation, with stress and anxiety but no change to the final outcome. In case two, though the financial and clinical aspects of a patient’s care are in fact separate issues, you can appreciate how this was blended in the patient’s mind and how this tactic damaged the relationship so that further communication was difficult and, again, resulted in an escalation that would likely not have occurred if they had dealt with one issue at a time.
Outcome
At the completion of both these matters, the final outcome for both Mrs B and Dr L was in fact fundamentally unchanged. Mr G’s review remained online and untouched, and Mr R’s specialist treatment and account were finalised in due course.
However, the path to these outcomes was rocky, with additional anxiety to all parties as a thorough investigation was layered on top of what was already a stressful situation. Fortunately for both of these practitioners, both investigations were finalised with an outcome of No Further Action.
The examples are shown not to demonstrate that one approach is better, or right, in any situation, but simply to highlight that, as with our clinical judgement, each situation must be assessed as though we all have standard procedures and practice protocols; there is no ‘one size fits all’ approach to resolving patient complaints and concerns.
Learning points
As with previous Tipping Point cases, it is important that we acknowledge a patient’s right to raise a concern or complaint.
When working through concerns with a patient, there is no ‘one size fits all’ path. As practitioners we individually assess each patient and plan accordingly. This holds equally true for complaint resolution for healthcare providers.
Taking an aggressive approach may be especially triggering for certain patients and inflame the situation further, even if it is in line with practice protocols.
In some instances, patients and practitioners will continue to have differing views and, in these situations, it may be all that can be done is to explain your viewpoint, acknowledge their differing opinion, and move forward. Even though this may be difficult and emotionally unfulfilling.