Depend on Staff to Manage Patients? Educate Them First.

Providing top-notch dental care goes far beyond clinical expertise. It takes the contribution of each team member to create a positive patient experience. But if practice owners fail to educate their team members on their roles, responsibilities and limitations, that positive experience can quickly turn negative. And that negative experience can potentially create a professional liability claim.

The Dentists Insurance Company reports a case in which a patient presented for veneers on teeth Nos. 5–12 and 21–28. Although the patient needed treatment on her posterior teeth, she insisted on addressing the anterior teeth first so that she could have a new smile by her daughter’s wedding, which was to be in a few weeks. Against his better judgment, the dentist agreed to rushing the treatment, as the patient was so insistent. He prepared and temporalized 16 teeth in one visit and seated the permanent veneers 10 days later. Initially, the patient appeared to be happy with her new smile. Because she was running late for another appointment, she left the office hastily without allowing enough time for adjusting her occlusion or taking any intraoral photographs. She promised to return after her daughter’s wedding when she had more time.

The patient failed her follow-up appointment but returned a month later complaining of sensitivity throughout her mouth. The dentist was able to see her right away, performed an occlusal adjustment and recommended seeing her again in two weeks. Three days later, she came in for her hygiene appointment and requested another occlusal adjustment. The staff informed her that the dentist wasn’t in the office and offered her an appointment the following day. The patient was upset and left without scheduling the next-day appointment.

Several days later, the patient called to report persistent pain and sensitivity. Rather than alerting the dentist, the front office staff told the patient that it was normal to feel pain and sensitivity following such procedures and advised her to wait until the follow-up appointment with the dentist, which was in a week. The patient emailed the office the following day requesting to be seen sooner. Staff responded to her email, letting her know that they did not have any available openings.

Frustrated with continued pain and sensitivity, along with lack of attention from the dentist, the patient requested her records and sought a second opinion. She reported that the new dentist diagnosed 10 teeth as needing root canal treatment due to excessive removal of tooth structure during the veneer preparations. She also informed the office that they would be hearing from her attorney. The office subsequently received a letter from an attorney representing the patient, alleging failure to treat properly, resulting in the need for endodontic treatment. The demand included a full refund of the treatment fees along with payment for future dental treatment and pain and suffering.

In this case, the breakdown occurred when the staff member failed to alert the dentist that the patient wanted to be seen sooner due to continued symptoms. The staff member took it upon herself to reassure the patient that her symptoms were normal and she would have to wait to be seen. In doing so, she took on the role of a licensed dentist, thus putting the practice at risk. Had the staff member notified the dentist of the patient’s concerns, the negative patient experience would have been avoided and the outcome may have been much different.

TDIC reminds practice owners that while empowering staff to make decisions is important for the smooth operation of a practice, staff must be educated on professional liability issues and associated risks. Training, procedures and protocols for risk management are essential to staff members’ understanding of their legal limitations. The following can help reduce your risk:

• Conduct a risk management assessment. Evaluate the awareness level of staff members and routinely conduct mock situations to determine how staff may respond.
• Develop written policies, procedures and protocols addressing risk management and liability and train staff on their implementation.
• Build a risk management resource library that includes your state’s dental rules and regulations, samples of appropriate documentation and a guide to dental terminology and abbreviations.
• Don’t rely on staff to communicate with unhappy patients. Instruct them instead to inform you of any patient complaints. Follow up with patients directly.

Before depending upon your staff to manage patients, make sure they know what they can and cannot do, what their limitations are, and what guidelines and protocols they must follow. Practice owners are ultimately held responsible for any decision and action that takes place within their practice.

Each member of your team is an extension of your practice and a representation of your office philosophy. A team approach ensures coordination, communication and continuity of care among everyone involved. Just as the doctor-patient relationship affects a patient’s course of treatment and satisfaction, so do relationships among dental staff. Ensuring every staff member is properly trained on issues relating to liability can help mitigate your risk. Staff feel empowered and supported when their roles and responsibilities are clearly outlined. They are more confident in their decisions when they clearly know when to handle issues themselves and when to refer to the practice owner for guidance.

TDIC’s Risk Management Advice Line is a benefit to TDIC policyholders. To schedule a consultation with an experienced risk management analyst, visit tdicinsurance.com/RMconsult or call 1.877.269.8844.