When an adult patient asked what could be done about the appearance of her teeth, her dentist recommended an extensive course of treatment, including orthodontic work and implants. The patient was happy with this plan and agreed to a referral to the practice's visiting orthodontic specialist.

The patient visited the orthodontist for more than a year but became frustrated with the length of time the treatment was taking and left for another practice. She later made a complaint and demanded a refund.

Although the practice responded to her complaint, the patient was not satisfied and reported the orthodontist to the GDC which commissioned a clinical assessment of the orthodontist's care. This identified a number of deficiencies regarding his assessment, treatment planning, record-keeping and complaint-handling. The GDC asked an Investigating Committee to consider the case and decide whether the orthodontist should face a public fitness to practise hearing.

Horrified that the GDC was investigating him, the orthodontist contacted the DDU for help. In preparing his defence, the DDU team encouraged the orthodontist to reflect on his interactions with the patient and consider whether aspects of his care had fallen short of his usual standards. These observations were included in the DDU's response to the GDC. The exercise also prompted the orthodontist to write his own response to the patient's complaint and refund the cost of her treatment.

The Investigating Committee found that there was a realistic prospect of proving allegations relating to the orthodontist's record-keeping and complaint management, but there was no evidence that his treatment was of a poor standard. The Committee also took into account evidence of the orthodontist's insight, his offer of a refund, and the fact that the allegations related to one course of treatment. In the light of this, it concluded there was "no real prospect of a Practice Committee finding the registrant to be currently impaired".

The case was closed with advice to the orthodontist about the need to work in partnership with patients when planning complex treatment and to ensure his clinical records were sufficiently detailed. He was also advised that patients' complaints should be "dealt with in a thorough, timely and open fashion."

Learning points:

• The treating dentist is best placed to address a patient's concerns so ensure you are involved in your practice's response to a complaint about your clinical care.
• Be prepared to reflect on the care you have provided and learn from errors. The GDC expects practitioners to demonstrate insight and evidence of remediation following an adverse incident.
• It can be difficult to keep detailed records when working in a busy environment. Try and develop ways of recording all the information that needs to be noted in an efficient way so that your records are not criticised when viewed by a third party such as the GDC.