Expertise with integrity

Who’s Listening Anyway?

How poor communications break the circle of trust between patients and healthcare providers.

It is a tooth universally acknowledged that a single failure in good communications can land a dentist in want of a lawyer. Yes, I’m in Jane Eyre country and during my 20 years of practice in Bath and as an expert witness for medico-legal reports, I’ve learned that poor communication is the Northanger Abbey of reasons for patient litigation.

In fact, more than 70 per cent of complaints can be attributed to poor communications, according to a review by a leading UK dental defence indemnity insurer. Their report highlights indelicate vocabulary, brusque delivery and a poor chairside manner as key pointers towards a lack of compassion for the patient. And with our medical litigation rates knocking the stars and stripes off North America’s figures, this is a very serious matter for me and my fellows in the UK. Here, medical and dental practitioners have a four-fold greater chance of litigation compared with practitioners in New York.

However, communication is a two-way street. And effective communication begins with listening. And listening opens the door to understanding and trust, which is a great start to resolving any cracks that might appear. Trust me, I’m a dentist

Yet while the charnel house of healthcare litigation is piled high with the complaints of patients unhappy with the quality of care, when it comes to the clinching question of trust, things don’t seem quite as gloomy for dentists as they do for doctors.

Research conducted by Bray Leino for the British Dental Health Foundation uncovered the warming news that people have more trust in dentists than doctors. 88 per cent of people surveyed claimed a very high degree of trust in their dentist, more so than in their doctor. Twice as many people (19.7 per cent) value their relationship with their dentist over their doctor (9.9 per cent).

So why is it, then, that so many patients fail to act on our advice? I am too often riled when I’m asked to assess a patient for a medico-legal report, only to find that they are suing their dentist for negligence, while at the same time neglecting themselves when it comes to the very basics of dental hygiene – like brushing their teeth regularly. And not smoking.

The case of the missing gum disease

In one particular case I advised on, a lady was suing her dentist after 30 years of routine care. Finding herself needing emergency treatment, she attended a different dentist, who diagnosed advanced periodontal bone loss and imminent loss of several teeth. The unfortunate woman reported she was wholly unaware of the disease, which is when she commissioned a lawyer to sue for breach of duty for the costs of remedial dental treatment. This would include implants and crown work, which would likely total a five- figure sum.

When I examined the patient, it was clear the disease was at an advanced stage and we discussed treatment options of removable and fixed prosthodontics. The patient was very distressed about losing her front teeth. Both parents had worn complete dentures, which she had been determined to avoid during all those years of giving up smoking. Unsuccessfully. Cigarettes were her comfort for the stresses of life. When writing my reports as expert witness, it is part of my protocol to ask for the patients’ medical and dental records – including all dental practitioners before, during and following treatment by the defendant.

This gives me the entire story. Regrettably, records showed the defendant was a little too economical with his notes. Although his 2011 – 1014 notes made references to “ANUG” –  Acute Necrotising Ulcerative Gingivitis, a serious infection of the gums that causes ulcers, swelling and dead tissues in the mouth – “gingivitis”, “heavy calculus deposits” and level three gum disease, there was no reference to pocket charting, bleeding indices or plaque scores. Schoolboy errors.

Notably, our defendant had specifically recorded gaps between the front teeth that were causing the patient concern. He had clearly instructed her on oral hygiene repeatedly, and performed scaling. At her last visit to him, he again recorded her poor oral hygiene and bleeding.

What he seemed to have missed, however, was the diagnosis the second dentist discovered: advanced periodontal disease. This second dentist referred her to his hygienist for full pocket, plaque and bleeding indices before embarking on a programme of oral hygiene, scaling and root planning. At this point, dear reader, you may well point your finger and shake your head at the initial practitioner. The indemnity insurers will reach for their cheque books. Settlement figures will be high.

Listen… with your eyes

But I had yet to examine her medical records. They made for difficult reading, uncovering a history of long-term depression with anti-depressant medication prescribed over 30 years. The patient had suffered breast cancer with surgery, radiotherapy and chemotherapy in 2011. Her separation from her husband in 2012 quickly led to divorce. Within the year her son would die in a motor bike accident and her daughter would be diagnosed with drug dependency…

And yet after all this, when I examined her, she still had plaque covering all her teeth even after she had been repeatedly warned of the causes of her periodontal disease. My report ended with conclusions that the patient had continued to ignore oral hygiene instructions by both dentists even after she had been informed about the disease. In all probability, the deterioration of her periodontal disease was inevitable due to poor compliance. Pointing the finger of blame to the first dentist due to her own failings was noted. The case was dropped.

This is why the author NEVER accepts desktop commissions only and DEMANDS that the patient/claimant is examined on every report commissioned.