Treatment co-ordinators – some risk management considerations

Treatment co-ordinators can be an asset to a dental practice, as long as their role is clearly defined and explained to patients.

Although dentistry is at its core focused on oral health, clinical techniques and approaches have developed, and the range of treatments that dentists are able to offer their patients has expanded. The obvious benefit is an increase in both patient choice and the ways in which dentists can assist their patients.
There is certainly a great deal more interest in, and demand for, cosmetic dentistry. The online world has exposed people to ever-greater levels of expectation and pressure to look good. Attractive teeth have always been valued and have now become even more of an aspirational commodity. This is reflected in the ways that patients seek information on and engage with dental treatment. Against this backdrop, the role of ‘treatment co-ordinator’ has become an established concept in some areas of practice.
The whole idea of treatment co-ordinators is not entirely new. They have been around in one form or another for a while now, but it’s fair to say that it is a role that has become more of a feature in recent years.

Benefits of appointing a treatment co-ordinator
There are clearly benefits to both clinician and patient in ensuring that patients are as well informed as they can be about treatment options. In some cases, a treatment co-ordinator can be the liaison between patient and dentist, and act as a personal guide to assist patients with their dental journey by being able to offer explanations in patient-friendly language.
They are often a first contact point with prospective patients who may be interested in exploring possibilities before organising an appointment with the dentist.
Treatment co-ordinators may also be involved in more traditional ‘front-ofhouse’ tasks, such as booking appointments, and it is not unknown for the treatment co-ordinator role to be carried out by a member of the dental nurse team who works chairside as well.
There are a number of benefits to the practice in having such a role. It can allow team members to expand their skills and make the most of their experience in communicating with patients. In terms of potential benefits for patients, having a treatment co-ordinator can allow a patient the opportunity to express their priorities and concerns, as well as obtaining a general idea of treatment possibilities and potential costs, without having to see a dentist. This can be helpful if, for example, a patient is embarrassed by their teeth and doesn’t know where to start. After speaking with the patient to establish their views and priorities, the treatment co-ordinator can book an appointment with the appropriate dentist.
Further to being seen by the dentist, the treatment co-ordinator can help with explaining the various stages of the planned treatment and clarify any outstanding questions on how long it will take, what is involved, how much it will cost, and payment options. Patients can sometimes find it easier to speak to a non-dentist, and may be less embarrassed to ask questions or seek further explanations.
The potential benefit to the dentist is that delegating some tasks can allow them to concentrate on dentistry and allow other team members to play to their strengths. Discussing payment plan options may not be a good use of clinician time. From a commercial perspective, it can reduce appointment slots being used on patients who may simply be fact finding: a treatment coordinator may help to sift out patients who are only ‘window shopping’, or those with unrealistic expectations in relation to timeframes or costs.

Suggested explanation for patients of the treatment co-ordinator role:
“An appointment with a treatment co-ordinator is a preliminary consultation to discuss treatments available at the practice. It is not a substitute for a clinical examination. All patients will require a full assessment examination before any decision about treatment can be made.”

“Potential options and costs given by the treatment co-ordinator are intended simply as a general guide. A full clinical assessment with the dentist will be required to obtain an accurate view of the possible treatment options and costs.”

Potential risks
While there are many benefits, it is important to take note of potential risks. With respect to a treatment co-ordinator and the information presented, there is a need to ensure that patient expectations are accurate. The patient needs to know that a treatment co-ordinator is not a dentist, and although they are able to address general questions, they will be unable to give specific details. What may be achievable, after a full clinical assessment, might be very different to theoretical options, and the patient needs to understand this. Only after the dentist has carried out an assessment will there be definitive information to indicate which options are appropriate and feasible. Unless information is delivered carefully, a meeting with a treatment co-ordinator may unintentionally reinforce – or generate – unrealistic expectations.
It is worth having some form of explanatory material for patients to help manage expectations (see panel). The treatment co-ordinator may be able to identify what the patient wants but it is only the dentist who can figure out what can actually be achieved and there is a line between outlining the types of treatment that might be possible and giving advice on actual treatment options.
Dentistry is strictly regulated, and it is important to ensure that a non-registrant does not stray into the area of what may be considered the practice of dentistry, or that a registrant does not exceed their own scope of practice.

Ethics and communication
Careful consideration must be given to ensuring an ethical approach to promoting treatments. There is a risk of enthusiasm and positive promotion spilling into the territory of hard sell or focusing on certain treatment options while overlooking other, perhaps less profitable, options that the patient really should be offered too.
When considering options, particularly for elective, aesthetic-based treatments, patients will need cooling-off time to reflect before committing to anything. They do sometimes change their minds. It is always better that this happens before treatment rather than during.
Good team communication is essential. If the transfer of information between the treatment co-ordinator, the dentist and the rest of the team is not clear and consistent, there is plenty of scope for misunderstandings and patient dissatisfaction.

Obtaining patient consent is an area ripe for misunderstandings. Consent is a process that involves information sharing, checking, understanding and obtaining agreement. A treatment co-ordinator can be a source of information about types of treatment, but they are not in a position to obtain valid consent for a particular type of treatment. They cannot provide the patient with the information specific to that patient’s particular clinical presentation and individual treatment need. Only a dentist can assess the full clinical picture, and go over the specific risks and benefits of the various treatment options for that patient.
Although there are benefits to a practice from the use of treatment co-ordinators, it is important to understand the boundaries within which they should operate.
It is the responsibility of the treating clinician to ensure that the patient understands the information, the risks and benefits of treatment, the alternative options, and has chosen freely to proceed with the treatment. It is vital that the dentist does not abdicate responsibility for this through the view that consent is ‘taken care of’ by a treatment co-ordinator. Only then can the role of a treatment co-ordinator become a mainstay of the modern dental practice.

Dr Martin Foster
Martin is Dentolegal Consultant at Dental Protection