There is a moment in every case where a disgruntled patient becomes a complainant. The Tipping Point is a series of cases and commentary that highlight that very moment.
When patients feel that their concerns are being ignored or dismissed, they often feel the need to raise their concerns elsewhere, seeking action or at times punishment of the practitioner involved. Sometimes this is simply because the patient wants to be heard and have their concerns validated and addressed.
The following cases share a point where each patient felt dismissed or unheard and, as a result, felt that further action was required.
Case one
Dr A had completed a surgical extraction of tooth 16 for Mr J. During the course of the extraction Dr A’s dental assistant (Ms Q) had left the room to retrieve additional surgical equipment to assist with Mr J’s treatment. As was her usual practice she had completed hand hygiene prior to leaving the surgery and returned with the sterile elevator and forceps inside their sterilisation packs.
Ms Q peeled back the bag, taking care not to touch the sterile elevator, for Dr A to retrieve the elevator and proceed with treatment. Ms Q then completed hand hygiene prior to donning her gloves and assisting with the final stages of extraction.
Mr J was concerned – he had noticed that Ms Q had not donned gloves prior to opening the sterilisation bag with her bare hands and he believed there had been a breach of hygiene standards. He raised these concerns with Dr A, who offered an offhand response: “It’s fine, the instrument is sterile, nothing to worry about.”
But Mr J was worried, and he felt that Dr A was covering up for Ms Q’s infection control breach. He wondered what else had happened during his treatment or what other shortcuts were being taken in the practice.Following Dr A’s dismissive comments, Mr J felt like he had no other option but report his concerns to AHPRA. He didn’t believe he would get any reasonable answers from Dr A, based on his previous attitude. Mr J alleged that Dr A and her staff had questionable infection control standards that needed to be investigated, and that this was a public health and safety issue.
Case two
Dr M was completing a restoration for Ms H, when a small child wandered into the surgery from the waiting room. Dr M and her assistant continued with Ms H’s treatment and explained to the child that he should return to his father.
The child did not leave the room but continued to observe Ms H’s appointment from the doorway. Ms H could see the child out of the corner of her eye, and she found this extremely distracting. The child tried to re-enter the room, but this time the child’s father came to the door and removed the child, apologising to Dr M and Ms H. Ms H felt extremely uncomfortable and embarrassed to be lying in the chair with her mouth open while the child and his father looked in from the doorway, albeit for a brief minute.
She raised these concerns with Dr M at the end of her appointment and Dr M made the comment “you know how little ones can be, they have a mind of their own” and laughed it off. Ms H felt that this was not an acceptable response, and in fact an invasion of her privacy. And further, that Dr M should have processes in place to ensure this type of thing didn’t happen.
She mentioned this again when settling her account at the front desk, where the staff seemed to understand but not appreciate how upset she was. Ms H had believed that that the intrusion by the child and then his father was a complete invasion of her privacy, while she had been very embarrassed while lying in such a vulnerable position in the chair.
Believing that her concerns were dismissed and of no importance to Dr M and her team, Ms H raised her concerns with the Office of the Health Ombudsman (OHO).
The Tipping Point
In both of these cases there were serious allegations made to the regulator, AHPRA, and the OHO about privacy and infection control breaches. Both patients felt that their concerns were valid, but that they were dismissed without reasonable or appropriate validation, explanation or discussion with regard to the incident that had occurred.
While neither complaint to the regulator was about the treatment provided by Dr A or Dr M, both cases share similarities in that the tipping point occurred when the opportunity to converse in a meaningful discussion with the patient about the incident was missed or dismissed. Both Mr J and Ms H believed that their concerns were not listened to and thereafter dismissed as not important. They then felt it was appropriate to escalate their concerns to someone who would listen.
Outcome
While Dr A was able to show that an infection control breach had not occurred, receiving a “no further action” outcome from AHPRA, the time and stress expended by Dr A and her staff when preparing her response for AHPRA was considerable. Had Dr A simply taken the time to listen to Mr J’s concerns and explain the premise of sterile equipment and their packaging, the breakdown in their therapeutic relationship and subsequent complaint to AHPRA could have been avoided.
Dr M acknowledged she had not taken the time to listen to Ms H’s concerns and, when reviewing Ms H’s complaint, had reflected on how vulnerable and uncomfortable Ms H had felt. Dr M had not considered how this had affected Ms H and reviewed the practice privacy protocols and patient accessibility to treatment areas. While the OHO outcome was “no further action”, Dr M was cautioned and reminded of her responsibilities and the necessity of ensuring patient privacy.
Learning points
- It is important to acknowledge your patients’ right to complain or raise a concern.
Remember that what may seem small, self-explanatory or not important to you as a dental practitioner and clinician, may in fact be extremely concerning or worrying to your patient.
- Providing a considered meaningful response, explanation or apology can often mitigate confusion, offer assurances both personally and professionally, and reduce the potential for escalation.
- Being dismissive of a patient’s complaint, which they have raised with you out of concern, often ends in one of two ways. The patient loses trust in you and the therapeutic relationship, and leaves the practice, or escalates their complaint to a third party for further investigation.
- The Code of Conduct sets out an expectation that dental practitioners will work with their patients to resolve their concerns and that “effective communication underpins every aspect of good practice”.1
1Code of conduct - Dental Board of Australia