It has long been recognised that there are particular risks associated with treating patients who we know little or nothing about.
It is also well documented that one of our best sources of protection when things go wrong is the ability to draw upon any preexisting positive relationship we have built up with a patient. Clearly if you spend a lot of your time treating new patients, you are denied this benefit. Indeed at the start of a dental career they will all be new.
Risks of complaints and litigation initiated by patients and family members are strongly influenced by:
- whether or not they like you
- whether or not they think you like them
- whether or not they think you care (enough) about them and/or are (sufficiently) interested in them
- whether or not they trust you and believe that you have their best interests at heart
- how important, special and valued you make them feel.
Predictability
Dimatteo and co-workers investigated whether or not it was possible to predict patient satisfaction and tolerance of adverse outcomes, in a study of 500 patients, split between those who had sued and those who had not, the conclusions were that:
- Patients noticed and responded to the non-verbal communication of the physician
- Patients formed views about the physician and his/her skills and level of care, based on their interpretation of 'body language'
- Physicians with the best nonverbal communication skills engender significantly higher levels of patient satisfaction
- When deciding whether or not to litigate, a dissatisfied patient would be strongly influenced by how they felt about the physician, as well as the actual treatment outcome.
Good communication right across the dental team, then, and the proactive development of rapport makes a major contribution to patient satisfaction.
It's mutual
Patients who have been given a basis upon which to trust and have confidence in a clinician:
- Are less likely to complain.
- Are less likely to sue the dentist - even when mistakes occur.
There are many reasons why we should try to find out as much as possible about our patients before embarking upon any treatment and wherever possible, deferring major or irreversible treatment until we have had time to build up a relationship and mutual understanding with the patient.
While this may not always be possible, we should at least always try to make the most productive use of the time at our disposal.
It is worth bearing in mind that we owe the patient precisely the same duty of care, whether we are seeing them for the first time or the hundredth time. At one extreme the danger lies in how little we know about the patient, while at the other extreme the danger is that we may think we know and understand the patient a lot better than is actually the case.
Consent
When meeting a patient for the first time, the clinician needs to make a judgement about the patient's competence and capacity to exercise their autonomy and free will in making decisions about their dental care. This can be difficult enough when treating longstanding patients and is fraught with risks when dealing with patients about whom we know very little. In any assessment of capacity there are a number of questions to ask:
- Can the person understand the information being provided?
- Can a person assimilate that information and appreciate its significance?
- Can the person weigh up alternative options in a balanced and rational fashion?
- Can the person make a decision?
- Can the person communicate that decision in a clear and unambiguous way?
The patient and clinician may not share the same first language, and even when they do, the words, phrases and 'jargon' used may create a further barrier to effective communication and mutual understanding.
Knowledge base
Another challenging aspect of the consent process when dealing with patients that we have only known for a short time, is that of deciding how much information we need to provide, and in what terms, in order for the patient's consent to be valid.
At the beginning of the consent process the clinician has the advantage of knowing much more than the patient does, about what the procedure involves, about its risks, benefits, limitations, about alternatives and how they compare in each of these respects and also in terms of relative costs.
On the other hand, the clinician may also be at a similar disadvantage in knowing relatively little about the patient, and his/her life and personal circumstances. Meeting a complete stranger is never an ideal starting point for carrying out any clinical procedure, but it is inviting disaster when contemplating any procedure that carries significant risks for the patient.
It will be obvious from the above that the less we know about a patient, the greater the risk that we will leave ourselves vulnerable to challenge in the consent process. For as long as the patient remains a relative stranger to us, the chances of us stumbling by chance upon the very information that has the greatest importance for that particular patient, are slender indeed. This underlines the wisdom of doing as little treatment as possible in the early stages, while trying to find out as much as possible about the patient and proactively building up a relationship with them.
Be aware
Any clinician who arrives in a new practice or other working environment, will encounter the same problem in that they will be forging fresh relationships with every patient they treat, for several months after starting work. This can be exciting and interesting, but also challenging and quite demanding. It is also a potentially dangerous time dento-legally unless one remains mindful of the risks and careful in their effective management.