Leaving a patient in discomfort while they wait for an appointment can carry risks.

Timing is everythingA dentist had treated an adult patient for almost a year. Recently the patient had attended with pain when biting on the right side of her mouth. No caries or fractured restorations were evident, and the radiographs didn’t allow the clinician to make a definitive diagnosis.
A provisional diagnosis of localised periodontitis was made and the dentist proceeded to treat the patient on this basis, with root surface debridement under local anaesthetic. This treatment was undertaken two weeks after the initial appointment. Two weeks after the second visit, the patient returned, having had no resolution of the symptoms and reporting that she had been in pain for a month. Indeed, the pain was increasing in severity to the point where it was described as excruciating, and she was unhappy.
After a further review it was discovered that a premolar had suffered a vertical fracture and needed to be removed. The dentist decided that the extraction was potentially difficult and advised the patient that he could not carry out the extraction the same day and that a longer appointment would be needed.
Unfortunately, the dentist’s appointment list was full and the next available “long appointment” was two weeks away. The receptionist explained this to the patient, who reluctantly agreed to wait a further two weeks for an appointment of the right length. The patient had now been in discomfort for several weeks but, as she trusted the dentist, she accepted that the wait was unavoidable.
The situation deteriorated and a few days later the patient called the practice in severe pain. She was seen by a colleague of the original dentist, who removed the fractured tooth the same day, without any difficulty.

The complaint
The patient was relieved that her tooth had been successfully removed and that her toothache had resolved. However, she was unhappy about the delay in receiving treatment, particularly as her dentist had advised that the extraction would be difficult and would need a long appointment, and this had proved not to be the case.
The patient wrote to the dentist complaining that she had been left in pain for more than a month and that he was uncaring.
With Dental Protection’s assistance, the dentist apologised to the patient and thanked her for making him aware of her concern. Having investigated the situation, he established that there had been a lack of communication between the receptionist and himself, which, in turn, left him unaware of the patient’s long wait for a further appointment.
He also explained the potential difficulty with the extraction and his reasons for seeking a longer appointment slot. He explained that he fully understood the patient’s concerns and that he would take steps to ensure that such a situation would not arise again. The patient accepted the apology and explanation, and this concluded the complaint.
She was particularly happy that her complaint had been taken seriously and that changes would be made at the practice, which meant that another patient would not have the same unsatisfactory experience.

Taking control of arrangements
The dentist in this case had been unaware that the patient would have to wait so long for an appropriate appointment slot, and when her letter of complaint drew this to his attention he was disappointed by the level of service that his practice had provided to the patient.
It was clear that the receptionist had not realised that the patient was in pain, and the dentist had not realised that his next available appointment was a matter of weeks away. There had certainly been a communication gap, and a conversation with his dental nurse and receptionist produced the necessary changes in the way that patients were prioritised.

Learning point
Patients in pain who are treated as soon as possible are inevitably very grateful and can become amazing ambassadors for your practice. Patients who appear to be left in pain are never grateful and often feel the need to tell their story to other people.
A patient who has their complaint resolved can often go on to become one of the dentist’s greatest supporters. A patient is often looking for an explanation and, where appropriate, an apology. The “wow” factor can be created by feeding back to the patient any changes that have been made as a result of the complaint.

MPS Dental Portraits and Groups

Dr Martin Foster BDS MPH DipHSM
Martin is a dento-legal adviser for Dental Protection and is part of the team supporting members in Ireland.