Case Study: Poor Response to Patient Concerns Contributes to Dental Claim
Effective communication skills to satisfy the patient-provider relationship can increase positive outcomes.
A 34-year-old male with unspecified gum and tooth disease presented to his dentist with tooth pain. Upon discussion, the patient and the dentist agreed upon a treatment plan, which consisted of extractions of upper teeth and denture placement. The teeth were extracted without incident.
The following day, the patient returned to the office and complained of severe pain in the upper jaw area. The dentist adjusted the denture and provided pain medication. The patient returned again the next day and complained that the severe pain had continued in the same location of his mouth. Although the patient stated that he had not worn the denture since the previous day, the dentist adjusted the denture. X-rays were not taken and the patient was released.
Six days later, the patient presented to a second dentist. The subsequent dentist x-rayed the area and noted that the tip of one tooth remained from an extraction site. He incised the gum and removed the tooth tip. The patient reported that the pain dissipated.
A claim of improper performance of a procedure was filed against the original dentist. In addition to the lawsuit, a board complaint was filed. Defense of the treatment provided was hindered because the dentist was unable to produce a dental record for the patient. The case was settled and the licensing board sanctioned the dentist.
Risk Management Discussion
Poor communication was a significant issue in this case. The original dentist failed to adequately listen to the patient’s concerns in conjunction with insufficient dental assessment of post-procedure complications. The lack of proper documentation was a key factor rendering the dentist unreliable in his own defense.
It has often been said that during a conversation, listening is twice as important as speaking. Effective communication is crucial to ensure that patients can make informed decisions regarding their care and understand how to participate in their treatment. It requires validation that the message has been appropriately heard and understood. Communication is not only a key component of successful patient safety initiatives; it can also be a predictor when determining if a patient will file a malpractice claim. Patients that sense empathy and understanding from their healthcare providers are often more likely to be compliant and participative in their treatment and more reluctant to file a claim in the event of an adverse or unexpected outcome. The following guidelines can improve your patient communication skills:
- Ensure that you have an awareness of the patient’s health literacy and construct your communication to the patient’s level.
- Elicit patient concerns by asking open-ended questions and acknowledging patient responses.
- Communicate information clearly and ask the patient to repeat the information to you to confirm the patient’s understanding.
- Show empathy by identifying and addressing areas that concern the patient.
- Train office staff to recognize complaints from patients or families that warrant immediate follow-up.
- Ensure that patients who experience complications are seen in a timely manner.
- Document all patient communication in the medical record regarding treatment and noncompliance.
Contact the Department of Patient Safety and Risk Management for guidance and assistance in addressing any patient safety or risk management concerns.
The guidelines suggested here are not rules, do not constitute legal advice, and do not ensure a successful outcome. The ultimate decision regarding the appropriateness of any treatment must be made by each healthcare provider considering the circumstances of the individual situation and in accordance with the laws of the jurisdiction in which the care is rendered.