Original article can be found on Oral Health website.
Every dentist shudders when they think about it: You’re going through the mail for your practice and amidst junk mail and bills, there’s an envelope with the Royal College of Dental Surgeons of Ontario (RCDSO) logo in the top left corner. It’s marked “PRIVATE AND CONFIDENTIAL.” You open it and are shocked to learn that the RCDSO is investigating a complaint that has been made against you.
How did this happen? What do you do next? Our goal in this article is to answer these questions. In the first part, we examine why complaints happen and how to structure your practice to avoid them. In the second part, we discuss the best course of action you can take when, inevitably, you receive that dreaded letter from the RCDSO.
Part 1: How did this happen?
A study performed by the RCDSO indicates that patient complaints fall into three major categories:
- clinical care and treatment outcomes;
- relationships and conduct; and
- practice management.
Examining each category provides insights about why patients complain, and how to prevent complaints from happening.
More than half of patient complaints relate to clinical care and treatment outcomes. With respect to clinical care, patients expressed dissatisfaction with the quality of treatment, including examination, pain management, treatment, and continuity of care. Complaints relating to treatment outcomes mostly concerned errors and safety, including diagnostic and procedural errors, and unexpected consequences or complications that might result from treatment.
To protect yourself against this type of complaint, it is essential that you ensure that the practice and care you offer meets the current standard of care. The RCDSO provides guidelines that are meant to educate and inform on the standards practitioners are expected to meet. You should review these guidelines against your own practices. Similarly, you should stay up to date on the latest scientific developments and their impact on standards of care; continuing professional development programs can be an effective and efficient way to do this. Finally, it is important that you communicate clearly and openly with patients regarding clinical care and treatment outcomes to set appropriate expectations.
Nearly one-third of patient complaints identified by the RCDSO were derived from poor or improper communication with patients. While this category encompassed a diverse range of complaints, most relate to issues of consent, professional care and conduct, and the accuracy of information provided by the dentist to the patient.
The best way to protect against this type of complaint is to facilitate open and transparent communications with patients, and to maintain thorough records in case of any misunderstandings. You should also remember that, as a dentist, you are ultimately responsible for the actions, including communications, of your employees including dental hygienists, dental assistants, and receptionists. As such, you should frequently and consistently review communication protocols and standards with all individuals involved in your practice. This not only helps avoid complaints, but also promotes a positive brand image and excellent customer service for your practice.
The third category relates to practice management which comprises about 15 percent of patient complaints. These complaints relate largely to administrative matters such as records and billings, practice cleanliness, and issues relating to access to care such as affordability. Many of these complaints can be prevented by implementing the recommendations above, including adopting RCDSO guidelines, creating open and direct communication channels with patients, and improving record-keeping practices. In the era of COVID-19, it is especially important that you implement the enhanced precautions recommended by the RCDSO, both to protect your patients and to prevent practice management complaints with respect to COVID-19 preventative measures.
Part 2: What do you do next?
Despite your best efforts, you have likely encountered patients who simply cannot and will not be satisfied. Regardless of how meticulous you are, you will likely receive a complaint at some point in your career.
The RCDSO is obligated to investigate every patient complaint, irrespective of how frivolous it may seem. As part of this process, you will be notified of the complaint and given 30 days to respond to it in writing. In most cases, your response will be provided to the Complainant who will have a further opportunity to comment. For that reason, care must be taken to respond fairly and earnestly, no matter your own views on the merits of the complaint.
All the materials generated as part of the complaints process, including your response, will then be submitted for consideration to the Inquiries, Complaints and Reports Committee (ICRC). While the ICRC may dispose of the complaint without taking any action, it may issue a verbal or written caution, or require the dentist to complete a remedial education program. These outcomes are serious as they are published on the College’s public register. In the most severe cases, allegations of professional misconduct or incompetence are referred to the Discipline Committee for a hearing; the personal, professional, and financial consequences of this can be extremely serious.
The entire process before the ICRC is conducted through paper transactions only. Dentists have no right to call witnesses or make verbal representations before the ICRC. This underscores the importance of maintaining excellent record-keeping practices since you may need to provide documents in response to a complaint for consideration by the ICRC. As soon as you receive a complaint, you should identify and make copies of the relevant records. These should be submitted as part of your response and will likely be asked for.
Given the paper format of ICRC, reviewing your written response to the complaint is vital. It is your one and only chance to explain your side of the complaint and to reduce any fallout from the process. Writing a good response requires careful consideration of your records, the results of the RCDSO investigation, and past decisions of the ICRC. It is important that your submission to the ICRC effectively address the complaint in a persuasive manner to convince the ICRC that the least severe outcome is appropriate.
Given the potential ramifications that may result from your response to the ICRC, you should consider hiring a lawyer who specializes in professional regulation to help you navigate the complaints process. An experienced lawyer’s support can significantly reduce the stress and effort associated with the complaints process and, ultimately, ensure that you achieve the best possible resolution.
GlickLaw is a boutique law firm focused on professional regulation, complaints, investigations, and discipline. If you have received notice of a complaint or investigation and would like to speak to a lawyer, please contact us.