Poor Response to Patient Concerns Contributes to Dental Claim

This case study examines communication factors contributing to an allegation of improper performance of a procedure involving extractions. The risk management discussion includes strategies to help dental professionals keep patients safe while mitigating risk.

A 34-year-old male with unspecified gum and tooth disease presented to his dentist with tooth pain. After a discussion, the patient and the dentist agreed on a treatment plan that consisted of extracting upper teeth and placing an immediate denture. 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 next day, the patient returned and complained that he continued to have severe pain 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 it again. No x-rays were taken, and the patient was released. The dentist was unable to produce documentation regarding the patient’s concerns, the dentist’s examination and treatment, and the differential diagnosis on the cause of the continued pain.

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 in an extraction site. He incised the gum and removed the tooth tip. The patient reported that the pain dissipated.

The patient filed a claim of improper performance of a procedure against the original dentist. Defense of the claim was hindered because the dentist was unable to produce a dental record for the patient. A licensing board complaint was also filed; the board sanctioned the dentist.

Risk Management Discussion

Poor communication was a significant issue in this case. The original dentist failed to listen to the patient’s concerns and to assess the post-procedure complications correctly. The lack of documentation—also a key factor—rendered the dentist unreliable in his own defense.

Effective communication is crucial to ensure that patients can make informed decisions regarding their care and to help them 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 who sense empathy and understanding from their healthcare providers are more likely to adhere to the treatment plan and participate in their treatment, and they are more reluctant to file a claim in the event of an adverse or unexpected outcome.

The following strategies can help dental professionals improve patient communication skills and dental record documentation:

• Determine the patient’s health literacy and tailor communication to the patient’s level. (See our article “Challenges of Cultural Diversity in Healthcare: Protect Your Patients and Yourself.”)
• Elicit patient concerns by asking open-ended questions and acknowledging patient responses.
• Communicate information clearly and ask the patient to confirm understanding by repeating the information back. (See our article “Rx for Patient Safety: Use Ask Me 3 to Improve Patient Engagement and Communication.”)
• Show empathy by identifying the patient’s concerns and addressing them. Repeat patient visits for the same concern should prompt thorough examination to determine the cause.
• Train office staff to recognize complaints from patients or families that warrant immediate follow-up. (See our article “Telephone Triage and Medical Advice Protocols.”)
• Ensure that patients who experience complications are seen in a timely manner.
• Document all patient communication in the dental record regarding examination findings, differential diagnosis, treatment plan, patient adherence. (See our article “The Faintest Ink: Documentation to Defend Quality Patient Care.”)
• Follow state and federal regulations on maintaining patient dental records. (See our article “Medical and Dental Record Retention.”)

For guidance and assistance in addressing any patient safety or risk management concerns, contact the Department of Patient Safety and Risk Management at (800) 421-2368 or by email.