Michael KilcoyneANN-MARIE HARDIMAN spoke to Michael Kilcoyne, mediator of the Dental Complaints Resolution Service, about his interactions with patients and dentists, and what issues are emerging.

The Dental Complaints Resolution Service, which is supported by the Irish Dental Association, was established to offer patients the chance to resolve complaints about their dental treatment in a fair and timely manner. Michael Kilcoyne, Chairman of the Consumers Association of Ireland, was appointed mediator of the Service, which is based in Mayo, and he has been dealing with a wide range of issues from patients and dentists since the Service was launched in May 2012. In fact, demand for the Service has been greater than anticipated.

“It has been a lot busier than I expected in terms of numbers. I expected about 100 complaints in the first year, an average of about two a week, but we are almost at 100 now after less than seven months.”

In fact, the Service has dealt with more than 80 complaints so far, most of which are still in process, with a small number resolved to the satisfaction of both dentist and patient. A very small number of dentists have had two complaints made against them, but in general complaints are spread around the country.

It’s good to talk
According to Michael, patients telephone initially to tell their story and find out if he feels that they have a valid complaint. Some may also have contacted a solicitor, but are unsure as to the best course of action to pursue. Others simply want to talk about what has happened to them with someone in an official capacity. Some have even been referred to the Service by their dentist. Michael then asks them to put the issues they have related to him in writing as the next step in the process. Once he receives this written complaint he can then contact the dentist involved to inform them that the complaint has been made and give them the opportunity to respond.

In a number of cases, the written complaint never materialises. “It’s very easy to complain over the phone, but much more difficult to put it in writing,” says Michael.

At this initial stage, Michael will also try to establish communication between patient and dentist.

“I will always ask patients: ‘Have you spoken to your dentist?’ There is generally a good relationship between patients and dentists. In fact, even when talking to me about a complaint, many patients will praise their dentist.”

Grounds for complaint
Patients complain about a range of issues, not all of which fall within the Service’s remit.One common situation arises when a patient has had dental work performed abroad, and subsequently experiences problems. The patient then visits a local dentist to have the problems fixed, and if this does not happen, they may complain to Michael.

Michael has also spoken to a significant number of patients who are extremely unhappy that treatments they were previously entitled to under the PRSI or medical card schemes are no longer available to them.

“PRSI patients argue that they are paying twice, and patients with medical cards find that they are not entitled to certain treatments.”

Unfortunately, Michael can only refer these patients to their local TD.

Michael has also been contacted by a dentist about non-payment of a patient’s bill, but this does not fall within the remit of the service and Michael reminds dentists that there are formal procedures for pursuing monies in these circumstances.

The issues
At any time, Michael can be dealing with a number of complaints that are at different stages: awaiting written confirmation of the complaint from the patient; awaiting a response from the dentist; or in discussion with a view to resolving the complaint.

While unable to comment on individual cases, Michael summarises the types of issues that he has dealt with during the year. Patients complain about poor clinical treatment (the dentist extracted a tooth but left the root in place), poor communication (‘the dentist was rude to me’), and price (‘treatment was too expensive’, or ‘extra costs came up once treatment had started’). Complaints about fees apply mainly to major, expensive procedures such as implants.

In Michael’s opinion, what the vast majority of cases demonstrate over and over again is the need for the highest standards of communication between dentist and patient.

“The dentist and their attitude to the patient is critical. The dentist must explain everything clearly – all the steps of the treatment, why the patient might experience pain, the costs involved … If there was more communication between patients and dentists, it would dramatically reduce the number of complaints.”

When contacted about a patient complaint, most dentists are very co-operative. Michael always asks the dentist for their view of the complaint, and advises them to contact their indemnity provider as a precaution.

“If the dentist responds promptly and says that they are doing that, it shows that they are taking the complaint seriously. Most are very good and want it sorted out.”

While Michael feels that the majority of cases can be resolved to the satisfaction of all parties by the DCRS, he is dealing with a small number of cases that he feels will have to go further. In the case of a particularly serious complaint, or one where resolution proves difficult, Michael consults a panel of experts, which looks at the case and makes recommendations. He emphasises, however, that these are not binding.

“This is a voluntary scheme – the dentist or patient can opt out at any time. It needs buy-in from both parties in order for it to work.”

He emphasises that the majority of patients have very reasonable expectations of the complaints process, and that most continue to have great respect for their dentist.

Patients as consumers
As Chairman of the Consumers Association of Ireland, Michael has a wealth of experience in dealing with consumer affairs issues, and he sees some parallels with the complaints that arise between patients and their dentists.

“Patients feel: ‘I’m buying the dentist’s time and the dentist should give me their attention during that time’.”

Patients increasingly see dental care as a service that they are paying for, and expect value for money and, importantly, for the dentists to see the relationship in the same light. Dentists, however, have traditionally viewed the relationship less as a commercial one and in more vocational terms, but Michael feels that they must become more aware of how patients feel.

“If you’ve no customers, you’ve no business. The best advertisement is a happy patient, because they will tell other people.”

Equally, patients will tell people if things go wrong, but even this can be turned into a positive if they can then say that the dentist responded well to the complaint and it was resolved quickly.

This all comes back to communication, and Michael feels that this is by far the most important message to relay to dentists:

“Communicate with your patients. When an issue arises, give it priority.”
In his first correspondence with a dentist, he always encourages them to contact the patient, so that, if possible, the dispute can be resolved without any further intervention.

“In my opinion, dentists should contact patients directly in such cases.”

The Dental Complaints Resolution Service (DCRS) offers patients and dentists an opportunity to settle their differences with the help of an experienced mediator. The Service is free of charge to patients and IDA members (non-members must pay a fee).Further information about the Service is available on its website – www.dentalcomplaints.ie.

Common complaints made to the DCRS:
• problems with quality of clinical treatment;
• complaints regarding dentist’s attitude;
• patient seeking refund for work they feel is unsatisfactory;
• patient feels treatment is too expensive;
• patient feels they did not give full consent for treatment; and,
• pain after treatment.

Web stats
Since the Dental Complaints Resolution Service was launched in May 2012, there has been significant interest in the Service, which can be seen in the steadily increasing visits to its website – www.dentalcomplaints.ie. Since May, the website has had 18,304 hits, which represents 4,979 individual visits. The number of visits to the site was high from the beginning (942 separate visits in the launch month), and has risen steadily to 1,302 visits in October 2012.

Public servant
A native of Louisburgh in Co. Mayo, Michael now lives in Castlebar. He is an elected member of Mayo County Council and Castlebar Town Council, and has served as Mayor of Castlebar on two occasions. He is currently the Chairman of the Consumers Association of Ireland. He has served for five years on the Dental Council and is a member of the Fitness to Practice Committee. In addition to all of this, he has over 30 years’ experience as a trade union negotiator and specialises in employment law and consumer law. When he has time after all of these activities, he enjoys walking, reading and sport.