Complaint about 'unimpressive' tooth whitening

I have only recently joined my first practice as an associate and I am dismayed to have received my first complaint. The patient told me she hated her discoloured teeth as soon as she sat in the dental chair. She is a smoker, so I tried to explain that this habit was contributing to the problem but she forcefully told me this was none of my business and demanded that I whiten her teeth. I reluctantly agreed as I did not want her to criticise me to my new employer. Unfortunately, this has backfired because she has written to complain that the results have been unimpressive and her teeth are now very sensitive. The complaints manager has asked me to a meeting with her and the practice principal to discuss the patient's grievances. What should I do?

DDU advice

This is a worrying time but try to stay calm because the practice will want your input when responding to the patient's complaint. 

First review your notes and write a factual account of your interactions with the patient for the complaints manager. This should include the oral health advice you offered, warnings you gave about the treatment and its possible side effects, and aftercare advice. 

During the meeting, a calm, professional manner is important. Be honest and open about your motivation for providing treatment and show you have reflected on what happened, rather than seek to justify any mistakes. 

The complaints manager should show you a draft of the practice's written response before it is sent, so that you have an opportunity to correct any factual errors. The response should deal with all the points raised in the complaint and may include an invitation to discuss the matter further, an apology and even a goodwill gesture. If you have concerns about the content, discuss these with the complaints manager or seek DDU advice. Do not delay because the response must be sent within strict time limits.

In the DDU's experience, most complaints are resolved locally, but if the patient is not satisfied she may take her case to the Dental Complaints Service (DCS). The DCS reviews complaints about private treatment and is only concerned with the way the complaint was managed (rather than your professional abilities). In such cases it will help if your practice can demonstrate that it responded constructively and in line with its own published complaints procedure.

Receiving a complaint can be frustrating and stressful, especially if you have made every effort to keep the patient happy, but try to learn from this experience. 

Dental professionals are expected to provide treatment which is appropriate and in the patient's best interest, and to warn of the risks and limitations of treatment. You should never allow yourself to be persuaded to prescribe treatment against your clinical judgment. Equally, if you believe the patient's expectations are unrealistic, it may be wiser to refer them to a senior colleague. Saying no usually gets easier with experience, but if you find it difficult, it may be worth seeking advice from practice colleagues or attending course to improve your communication skills. 

Hands-on training

I am a dental hygienist. I was unable to attend my practice's medical emergency hands-on training session last week. Will a medical emergency course which is not hands-on suffice as the core annual requirement, or do I need to attend a hands-on course?

DDU advice

The GDC's Standards for the Dental Team says that dental professionals "must follow the guidance on medical emergencies and training updates issued by the Resuscitation Council (UK)" (paragraph 1.5.3).

The Resuscitation Council’s own Quality Standards for CPR in Primary Dental Care, says that dental practitioners and healthcare staff should be trained in cardiopulmonary resuscitation (CPR) so they can:

• recognise cardiorespiratory arrest;
• summon help immediately;
• start CPR, using chest compressions and providing ventilation with a pocket mask or bag-mask device and supplemental oxygen;
• attempt defibrillation (if appropriate) within 3 minutes of collapse, using an AED; and
• provide other advanced life support skills if appropriate and if trained to do so.

It recommends that knowledge and skills are updated at least annually, including hands-on simulation training and assessment for clinical staff. This guidance can be found on the Resuscitation Council website.

It follows that the GDC expects clinical staff members to complete annual hands-on training. In addition, it requires those in a management role to "ensure that all members of staff who might be involved in dealing with a medical emergency are trained and prepared to do so at any time and practise regularly in a simulated emergency so they know exactly what to do." (Standards for the Dental Team, paragraph 6.6.6)

Speak to the person who organised the practice training session as they should be able to help you enrol in a suitable hands-on course.