Managing patient expectations in dentistry

It’s well recognised that patients don’t necessarily complain simply based on their clinical outcome.  Most dentists will have heard of or seen situations where a patient has experienced an outcome which wasn’t ideal yet wasn’t particularly poor, however the patient has been quite annoyed with the outcome and has lodged a complaint.  On the other hand, there are many cases of patients who have experienced quite poor outcomes yet have chosen to not complain. 

There are many reasons why the above may occur, some which are easier to identify than others.  All patients are different and human behaviour isn’t always predictable.  Good communication and the relationship between the patient and dentist will greatly influence the likelihood of a complaint.  One other very important factor is the expectations of patients.

Patient expectations

Many patients will go into dental appointments with some level of expectation regarding their likely outcome.  They may have a very clear and detailed outcome in mind or it may be more broad and open.  Most importantly, some of these expectations will be realistic, however others won’t be.

Unrealistic patient expectations pose very real challenges for dentists.  If a patient undergoes treatment which they have unrealistic expectations about, it’s unlikely those expectations are going to be met simply due to them being unrealistic.  If a patient’s expectations haven’t been met, it’s likely the patient is going to be unhappy or dissatisfied with the treatment.  Those unhappy and dissatisfied patients are the ones more likely to complain about the treatment and expect further corrective treatment or compensation.  It’s therefore vital that dentists do all they can to help the patient fully understand treatment and the likely and possible treatment outcomes before treatment begins.

Creating realistic expectations

A key step in making sure a patient has realistic outcomes regarding treatment is to have an open and honest conversation with them.  This will not only provide the patient with information about their treatment, it will also give the dentist a clearer understanding of the patient’s expectations.  A dentist’s clinical skills are vital to what they do, however effective communication goes a long way in providing positive outcomes.

To assist a patient to have realistic expectations, dentists must ensure they explain the treatment and outcomes using simple, clear terms.  Technical clinical language should be avoided as many patients won’t understand this.  Dentists should also consider how they tailor their language and the information for each individual patient.  For example, a person with language or literacy challenges may need information presented in a more detailed manner than other patients.  Dentists should also consider using diagrams, pictures or models to assist with understanding where appropriate.

When discussing treatment with a patient, it’s important that dentists don’t make assumptions about what the patient will or won’t understand.  It’s easy for dentists to become so familiar with what they do and know that they sometimes forget how foreign that knowledge can be to other people.  Patients will have varying degrees of knowledge and experience regarding dental treatment.  Therefore, what they understand about their treatment will also vary. 

When a patient attends a dental practice and requests a particular type of treatment, this is an occasion when a dentist should be especially mindful of the patient’s expected outcome.  When a patient has requested a type of treatment, the patient has clearly formed a decision regarding what treatment they need to get the outcome they desire.  What they’re requesting and expecting may be reasonable and realistic, however in some cases it may not be.  When presented with this situation, dentists need to be sure they don’t rush into providing the patient with the requested treatment.  As with all patients, there needs to be a thorough assessment and diagnosis process.  Then the patient is to be provided with their treatment options, as well as the risks and benefits of those options.  There may be treatment options which are more suitable which the patient isn’t aware of.  The patient also needs to be made aware of the likely treatment outcomes for each of those treatment options.

The dentist needs to be sure the patient has all required information before consenting to treatment and this includes understanding the likely outcomes.  A patient’s request for particular treatment doesn’t alter this required process.  And dentists need to remember that they’re always responsible for the treatment they’ve provided, regardless of whether it was requested by a patient.

In summary…

Dentists should be doing all they realistically can to improve the outcomes for their patients and reduce the likelihood of poor outcomes and complaints.  An important step in this process is making sure patients have realistic expectations regarding treatment outcomes.  Dentists have a very important role in using their clinical knowledge in conjunction with practical terminology to assist patients to develop realistic expectations.  Dentists need to remember this is of great benefit to both themselves and their patients.


Managing Patient Expectations in Dentistry

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    Using Telehealth during the pandemic

    Many allied health practitioners across the country are already using telehealth to provide care for their patients during the COVID-19 pandemic. However, there are some additional risks and limitations associated with delivering health services via telehealth which practitioners need to be mindful of.

    Using telehealth to deliver allied health services to patients during the pandemic? AHPRA releases new guidance for all health practitioners.

    As part of the national health response to the COVID-19 pandemic, many registered health practitioners are electing to use ‘telehealth’ to deliver health services to their patients.  The Australian Government has demonstrated support for this initiative by rolling out new temporary Medicare Benefit Scheme (MBS) ‘telehealth’ item numbers, several of which apply to the provision of allied health services (including those which form part of chronic disease management[1]). 

    In an effort to support practitioners who wish to use telehealth to service their patients going forward, AHPRA has recently released new guidance (https://www.ahpra.gov.au/News/COVID-19/Workforce-resources/Telehealth-guidance-for-practitioners.aspx) which sets the expectations for all health practitioners delivering health services using videoconferencing or telephone solutions[2].  The key message is that a service may only be provided by telehealth where it is safe and clinically appropriate to do so.[3]  

    Critically, the limitations around the use of a telehealth consultation to provide a particular health service need to be at the forefront of practitioners’ minds and on a case by case basis.  For example, practitioners ought to consider whether this a consultation which, if conducted face-to-face, would add no further value than if conducted over the telephone?  Or, is this a consultation which requires a physical examination in order to properly diagnose the presenting complaint? If it is the latter, in our view it will not be sufficient to simply tell the patient about the limitations of a telehealth consultation and rely on this disclosure defensively without conducting the necessary examination. If required, further arrangements ought to be made to provide full and appropriate clinical care. This may mean arranging for an in-person consultation/examination for the patient with a colleague if you are unable to conduct it yourself. 

    So how do you perform a consultation via ‘telehealth’? While neither AHPRA nor the Department of Health has been prescriptive about the type of software or technology practitioners need to use to deliver telehealth services, the Department has made clear that videoconferencing services are the preferable substitute for a face-to-face consultation.  AHPRA has said that either videoconferencing or telephone is suitable.  However, both organisations have warned practitioners to ensure that their chosen software meets both their clinical requirements and satisfies privacy laws[4].  The MBS Online website refers providers to the Australian Cyber Security Centre website (https://www.cyber.gov.au/publications/web-conferencing-security) for information on how to select a web conferencing solution.

    Although the Australian Government has provided several new MBS telehealth item numbers for the provision of some allied health services, the items are very specific, and should be reviewed carefully as rebates may not be claimable if the service does not have an equivalent telehealth item number.  In addition, practitioners need to be mindful that the MBS items specify whether they are to be used for videoconferencing or telephone-only services – we recommend reviewing the schedule to ensure the correct number is used for billing purposes. 

    While it is a legislative requirement that some medical practitioners must bulk bill the new telehealth services for certain patients (including those who are more vulnerable to COVID-19), these requirements do not apply to allied health practitioners as of 20 April 2020.   Allied health practitioners may employ their usual billing practices for delivering services via telehealth. That being said, it is expected that practitioners will obtain informed financial consent from patients prior to providing any telehealth service, including providing details about the practitioner’s fees and any out-of-pocket costs. 

    Patient privacy is another key issue that allied health practitioners need to consider when using telehealth to conduct consultations.  AHPRA guides practitioners to confirm the identity of the patient at each consultation, which may be more challenging if telephone is used (as opposed to videoconferencing), or if the patient is a new patient for the practitioner.  Also consider the location and surrounds in which the telehealth consultation is conducted - if it is not at the practitioner’s usual practice site (for example, because the practitioner is conducting consultations from home), consider what measures need to be implemented to protect patient privacy during the consultation.

    Finally, all registered health practitioners who intend to use telehealth to conduct patient consultations ought to ensure that they have appropriate professional indemnity insurance arrangements in place for all aspects of their practice, including telehealth consultations. We encourage practitioners to contact their professional indemnity insurer about their intentions to use telehealth, and confirm that the appropriate coverage is in order.

    This article was written by Principal Kellie Dell’Oro and Associate Anna Martin from Meridian Lawyers. Please contact Kellie (kdelloro@meridianlawyers.com.au) if you have any questions or if we can be of assistance to you.


    [1] MBS Online Medicare Benefits Schedules – COVID-19 Temporary MBS Telehealth Services. (http://www.mbsonline.gov.au/internet/mbsonline/publishing.nsf/Content/Factsheet-TempBB)

    [2] AHPRA FAQ “Telehealth Guidance for Practitioners” dated 16 April 2020.

    [4] Ibid.

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    Transitioning out of COVID-19 restrictions

    Operating a business during the COVID-19 pandemic has presented many challenges. Unfortunately, many businesses closed for a period of time while others worked on reduced hours. And for others, staying open meant finding new ways of doing so, such as by providing virtual services. As the world starts to consider how to move out of pandemic restrictions, it’s important for all business owners to carefully consider the approach they’ll take and the associated risks. The fallout of COVID-19 is likely to be with us for some time, so we all need to be careful to not become complacent and make changes too quickly.

    Government requirements

    Firstly, all business owners need to be sure they’re keeping up to date with and adhering to government requirements and regulations. This can at times be challenging as the federal government is making recommendations, yet all state and territory governments are moving at different paces in terms of lifting restrictions. All business owners need to take responsibility for being sure they understand what they can and can’t yet do regarding their operations. Information about this can be found on the following websites:

    Australian Federal Government - www.australia.gov.au 

    ACT - www.covid19.act.gov.au

    New South Wales - www.nsw.gov.au/covid-19

    Northern Territory - www.coronavirus.nt.gov.au

    Queensland - www.covid19.qld.gov.au

    South Australia - www.covid-19.sa.gov.au

    Tasmania - www.coronavirus.tas.gov.au

    Victoria - www.vic.gov.au/coronavirus-covid-19-restrictions-victoria

    Western Australia - www.wa.gov.au/government/covid-19-coronavirus

    Business owners may also wish to seek guidance and clarification from their professional association.

    Gradual changes

    While it’s understandable that business owners want to get back to how things were pre-pandemic, it’s advisable that changes aren’t made too quickly. Rushing could see changes being made which aren’t allowed or aren’t safe if they haven’t been carefully considered. It could also result in staff not understanding the changes and not adhering to them as they should. It’s important to remember we may not continue transitioning out of restrictions. Unfortunately restrictions could at any time be wound back which is another reason why a planned and measured approach is ideal.

    All changes should be communicated to clients. This means they’ll feel reassured and trust that your business is continuing to operate safely. It also helps your clients understand what you expect from them to maintain this safety. This communication can be done in a variety of ways, such as by simply posting notices around the premises or sending email updates.

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    Not all businesses and business owners are the same and therefore how they provide services during the period of restrictions and how they transition out of these will, and should, differ. You should consider the following when planning to transition out of restrictions:

    > Is the current way of working successful? If the changes you’ve made to the business during the restriction period have worked well for you, you may feel less urgency than others to move away from these.t of

    > Does the service you provide require contact with others? The services provided by some professionals requires them to come into close contact with their clients, whereas other services can be offered from more of a distance. When thinking about making changes to your services, you need to carefully consider how close this will require you to be to your clients and if this is something you think you can do safely.

    > Are your clients high risk in relation to COVID-19? If your clients are at an increased risk, possibly due to their age or health condition, this should be seriously considered when assessing how the business provides its services.

    > Are you, or someone you live with, high risk? It’s not just the health of your clients you need to consider when making decisions about how to run your business. You also need to consider your health and that of those you live with. Remember, this is a highly contagious virus which can have devastating consequences; please don’t risk your or another person’s health.

    Insurance cover

    All business owners and professionals need to be sure they have insurance to cover them for what they do. During the period of restrictions, when some professionals changed the way they were working this led to changes in their insurance cover. Therefore, as you come out of restrictions and again change the way you provide services, you need to be sure your insurance covers those services as well as the hours you’ll be operating and the estimated income.

    Trust your instinct

    There are unfortunately cases of clients pleading with business owners to open when they aren’t ready and even when in breach of government restrictions. This puts unfair pressure on business owners to do the wrong thing to keep their clients happy. Of course one of the core functions of running a business is to keep clients happy and satisfied, after all they keep you in business. However this can’t be done when it’s potentially detrimental to the health of you or others. When making changes to come out of restrictions, ensure these are planned, well thought through and explained to your clients. If they do try to convince you otherwise, reiterate your reasons to them and don’t allow yourself to be convinced to do something you know isn’t appropriate.

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    Navigating communication and due processes during COVID-19

    At Guild Insurance we thought it was timely to remind you of practices you should adopt to ensure you’re operating your business as safely as you can during the COVID-19 situation. 

    These include: 

    • Staying up to date with regulations 

    • Communicating clearly with customers and staff 

    • Taking actions to reduce the risk of spreading COVID-19 

    • Keeping records of what steps you put in place 

    Stay up to date with regulations 

    Firstly, please be sure you’re keeping up to date and adhering with Federal and State or Territory government requirements. To fully understand these requirements, it's always best to go directly to the source rather than rely on other media channels. The following links will provide you with the necessary, and regularly updated, requirements.   

    ACT 

    Communicate clearly with customers and staff 

    When operating any business, your communication is always incredibly important.  It keeps your clients informed of what they can reasonably expect from your business.  Communication also assists them to understand how the operations of the business and services provided impact them.  As we all deal with the challenges presented by COVID-19, communication from business owners and operators has taken on an increased importance. 

    We have seen an increase in complaints over trivial or minor issues. Some complaints have gone directly to the regulators and in a recent example, the police were involved. We believe this is likely the result of an emotional response to the stresses and anxieties people are experiencing as a result of COVID-19. While these complaints could be considered "over the top", they all require a response and may involve the stress of an inquiry by the regulator.  

    Given the circumstances we all face with COVID-19, we need to regularly remind ourselves that many people are struggling to deal with the current situation.  We recommend business operators be especially mindful of how they speak to and interact with their clients and staff.  Maybe you need to take a little more time than usual to explain business processes.   It might be ideal to provide written information to assist people in understanding the services you can and can’t offer and how you are helping to manage the risks associated with COVID-19.  Taking a bit more time and care to explain business processes and services, particularly if they’ve changed from the usual, will potentially mean your clients will be more understanding if their expectations aren’t met. 

    Take actions to reduce the risk of spreading COVID-19 

    As well as focusing on your communication, all business operators also need to be sure they’re doing all they can, and meeting requirements, regarding distancing and cleaning within their business.  Some processes you may consider, or possibly already have, for your business include: 

    • Restricting the number of clients in your premises at the one time.  Depending on the type of business, this can be done in a few ways such as having staff at the entrance managing who comes in and when and removing some chairs from waiting areas.  It can also be done by spreading out the time between appointments and asking clients to wait outside till called in for their appointment. 

    • Placing markings on the floor reminding people where to stand to ensure there’s the required physical distance between them. 

    • Encouraging cashless payments. 

    • Signage both on the outside and inside of the premises making people aware of your processes and what you expect from them when they enter. 

    • Having hand sanitiser available and in sight for all staff and clients. 

    • Regularly cleaning the premises, particularly high touch areas such as doorknobs.  There should also be cleaning in between clients if they come into contact with items such as treatment tables. 

    While all the above is important, just doing it isn’t enough, especially if you want to be sure your clients feel confident and safe using your business.  Again, communication is vital here.  Your clients deserve to know about the safety process within your business, so be sure you make them aware.  This can be done by emailing all clients about the process you’ve put in place.  You could put notices within and around the premises reminding them of your processes.  You and your colleagues should also be talking about the safety measures with clients, such as reminding them to apply hand sanitiser when they enter. 

    Keep records of what steps you put in place 

    Guild also recommends our insureds keep a record of their safety processes.  Like all record keeping, this serves as evidence in the unlikely, yet possible, event the processes are questioned. If a client or any other person accused you and your business of not adhering to safety requirements and restrictions, having this evidence will make it easier to prove otherwise.  Collecting and storing this evidence doesn’t need to be cumbersome.  It can be done by taking photos of items such as signage, floor markings and available hand sanitiser.  Copies of any written communication to clients, such as emails, should be kept.  You should also make a record of any situation where a client has seemed unhappy with your business.  Noting this down when it happens while it’s fresh in your mind will be useful if the client lodges a complaint. 

    Lastly, remember Guild Insurance is here to support you in the event a client makes a complaint.  Whether this complaint is to you directly or to a regulatory body, whether it’s about your processes during COVID-19 or the service you regularly provide, Guild is here to support you during the difficult and stressful period of managing a complaint.    

    Guild Insurance Limited ABN 55 004 538 863, AFS Licence No. 233 791.  This article contains information of a general nature only, and is not intended to constitute the provision of legal advice.  Guild Insurance supports your Association through the payment of referral fees for certain products or services you take out with them.

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