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News / December 19, 2008

The secrets of avoiding litigation in dental practice revealed

by Guy Hiscott

Earlier this year in Dublin, delegates were both informed and entertained by John Tiernan of Dental Protection speaking on the subject of how to avoid litigation in dental practice.

Before the main portion of the event got underway, Fintan Hourihan, CEO of the Irish Dental Association, welcomed the attendees and spoke about a number of the issues currently affecting the dental profession in Ireland, including the Oral Health Strategy and the forthcoming introduction of compulsory continuing professional development.

As a starting point, John explained that it is impossible to avoid making mistakes entirely, and that there is added pressure on dental professionals because, as he put it: ‘There is no correlation between patient experiences and patient treatment. Patient experience is the real issue here’.

Good communication is of the utmost importance, and as John pointed out, there is a difference between what comes out of your mouth and what goes into their ears!

Looking beyond the issue of litigation for a moment, delegates were shown how poor communication can impact on the business. Dissatisfied patients tend to tell others of their experience, nine out of 10 do not give the dentist the chance to put things right, while one dissatisfied patient equates to 10 recipients of bad news. Further, the truth is, the more complaints you get, no matter the reason why, the greater chance you have of being sued.

John said that, psychologically speaking, the decision to sue is made even before the event complained of if they perceive:
• An unwillingness to listen
• An appearance of not having sufficient time for the patient or of being rushed
• An impression of disinterest or even arrogance
• A lack of care or concern.

So what is the answer? Well, a bit of ‘chit chat’ can make all the difference, as it helps to build a rapport. It is not about the treatment provided but how it is delivered that features in most complaints. If you are technology focused, preoccupied by procedures and take little time to talk with your patients and to explain the procedures, these can all lead to problems.

To tackle the issue of miscommunication head on, John recommended remembering ‘you, you, you, you, not me, me me, me’, which translates into:
• Use the right words
• Understand the barriers
• Use the signals people give
• Use the ‘ABCDE’ of communication.

The ABCDE communication strategy is as follows:
• Ask three questions
1. Why are you here?
2. Where do you want to go?
3. How do you expect to get there?
• Be attentive; listen without interruption
• Clarify understanding
• Don’t lead patients to the wrong destination
• Explain objectives, pathways, benefits and risks.

There is also the issue of body language to be addressed in all this, with John stating that in fact only 7% of all communication is verbal. John presented a number of non-verbal tips for effective listening, including:
• Maintain as much eye contact as possible
• Look interested and use appropriate facial expressions
• Nod to indicate understanding and interest without interrupting
• Try not to fidget, such as tapping your foot or twirling a pen
• Use ‘open’ gestures as opposed to ‘closed’ gestures, for example avoid crossing your arms and leaning away from the patient.

John went on to show some footage of patient/dentist interaction and the consequences that can result depending upon the approach taken by the dentist, as well as highlighting the importance of appropriate record keeping. The overall message delivered here by John was that records must be clear, dated and contemporaneous.

Finally, delegates were provided with a practical checklist for obtaining consent from patients, to ensure they are aware of the purpose, nature, likely effects, risks, alternatives, likelihood of success and costs.

The evening was a huge success, with delegates agreeing that John’s presentation was not only hugely informative but great fun too. No doubt those who have already had the pleasure of listening to one of John’s presentations will be looking forward to him fronting Dental Protection’s next outing in Ireland.