TREATMENT: FIRM REBUTTAL
BACKGROUND: A 43-year-old woman, Mrs L, attends her dental practice for an emergency appointment
complaining of a severe toothache and swelling. She is seen by Mr B who on examination finds a grossly decayed and infected lower left
molar with swelling of the associated tissues indicating infection spreading into her jaw. Extraction of the tooth is clearly indicated and the dental records state: “ext LL6 with forceps uneventful”. Mr B also prescribes an antibiotic for the infection. Three weeks later the dental
practice receives a letter from the Citizen’s Advice Bureau (CAB) written on behalf of Mrs L. It states that later in the evening after her visit to the dentist she experienced symptoms of sickness and high fever. Her husband
PATIENT COMPLAINT: COLD REPLY
BACKGROUND: Mrs C, 53, has been unwell for several days, feeling weak and vomiting frequently. She has long-standing health problems, including a history of cancer, and has attended a number of hospital appointments over the previous 12 months. Fearing her health may be deteriorating, her husband calls her GP practice to request a home visit. He speaks to his wife’s regular GP, Dr M, who provides a phone consultation instead of a home visit. He writes a prescription for Mrs C with an increased dose of her existing medication for pick-up at the practice. Over the next few weeks Mrs C’s condition does not improve and Mr C makes further calls to the practice. Dr M continues to consult by phone but on two occasions the duty doctor makes a home visit. Initially Mrs C appears to be
responding well to medication but on the second visit she is referred to hospital. Her condition deteriorates further and she dies two weeks later. The practice receives a formal complaint from Mr C regarding the
SPRING 2013
standard of treatment his wife received in the months before her death. In particular, he is angry that Dr M ignored his requests for a home visit and insisted on telephone consultations. The practice responds by detailing the numerous contacts Mrs C had with the practice shortly before her death, concluding that Dr M acted appropriately in all instances. Mr C is unhappy and forwards his complaint to the health service ombudsman.
ANALYSIS/OUTCOME: Dr M seeks advice from MDDUS on how to respond to the ombudsman. An adviser explains that the practice’s initial response to Mr C’s complaint appears purely factual and lacking in empathy and did not address the specific concerns regarding the standard of care provided. She helps Dr M draft a suitable response that explains their clinical decision-making, including why home visits were denied. She advises the letter should also express concern
at the factual nature of the original response and explain that the practice will ensure future complaint responses fully address the concerns stated. It should also mention that the practice
held a significant event analysis in order to learn from the mistakes made. The ombudsman identifies a number
of failings in Dr M’s clinical decision- making and in the practice’s complaint handling but they accept the practice have taken steps to address these issues. The practice is advised to apologise in writing to Mr C and the matter is taken no further.
KEY POINTS • Ensure complaint responses address the complainant’s concerns and are not simply a list of factual statements about treatment provided.
• Seek advice before responding to patient complaints as an ill- conceived response risks further difficulties with the health service ombudsman.
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brought her to the local A&E where she was diagnosed with blood poisoning and admitted to hospital. She was discharged three days later. In the letter Mrs L alleges that it is clear the blood poisoning was a result of her dental treatment and she demands a refund of the dental fees and recompense for three days lost earnings from her job as a cleaner.
ANALYSIS/OUTCOME: Mr B sends the CAB letter to the MDDUS along with a suggested draft reply. A dental adviser liaises with the dentist on some of the wording. In his reply Mr B expresses his
regret that Mrs L had been hospitalised. He confirms that she did attend his surgery for an emergency appointment at which a molar was extracted following detailed discussion and with her consent. He explains that in most cases extraction is sufficient to resolve the symptoms and alleviate
pain and swelling but sometimes infection is too deep-seated and additional treatment is required. This is especially the case where infection is already present and the patient is a smoker with poor oral hygiene. Mr B points out that Mrs L has a
history of neglected dentition and that she rarely attends her dental practice except for emergency appointments. For these reasons he refuses to refund the treatment fees or offer compensation for the days off work. He further suggests that Mrs L be advised to regularly attend for dental treatment in order to prevent similar problems in future.
KEY POINTS • Advise high-risk dental patients of any potential complications after treatment.
• Record advice to patients on the importance of proper dental hygiene.
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