The health and safety of the public safety is the Council’s primary focus at all times.
The Council strives to achieve this by working with practitioners to ensure they are safe, competent and fit to practise. It is the role of the Health and Disability Commissioner’s (HDC) office to respond to concerns from the public about treatment they have received from health practitioners.
The Council is regularly contacted by patients concerned about the treatment they have received. If the complaint is in writing then the Council is required to forward it on to the HDC. However, often the patient will phone the Council, seeking advice on what they should do about their concerns. At this point, there is often an opportunity to suggest to the patient they return to their practitioner and discuss their disappointment with a view to seeking a resolution rather than lodging a formal complaint.
Other options which are sometimes suggested is to contact the professional association or the HDC Advocacy service with a view to mediation and possible early resolution.
Dealing with disappointed patients
When patients go back to their practitioners to discuss their concerns, there is a huge opportunity to resolve the issue without the stress and worry of dealing with a formal complaint. The Council’s experience is that complaints almost invariably involve a communication issue and frequently the relationship has broken down. This often leads to very challenging meetings with upset and angry patients.
Some helpful techniques include:
respond in a timely manner
avoid delays and choose an appropriate venue which may not be the surgery
encourage the patient to bring a support person
use active listening without interruption and demonstrate lots of empathy
look for solutions rather than attempting to establish that you have done nothing wrong.
Often when patients complain the first contact is with a staff member (receptionist or practice manager) rather than the individual practitioner. Having a strategy for the whole practice in dealing with upset patients can prevent an escalation of problems.
In the Council’s experience, critical comments made to patients by other practitioners can often lead to complaints being laid. If asked to comment on a colleague’s dentistry there are some important considerations:
provide a professional opinion without criticism of previous management
appreciate that you may not have all of the facts
be prepared to put your opinion in writing and have it scrutinised by others.
In dentistry today there are frequently differences in opinion on treatment decisions. For example in this situation some practitioners may continue to monitor, others may seal and polish and there will be practitioners who will advise replacement.
Under the new caries management systems there are now options to manage early caries by reversing the disease rather than undertaking surgical intervention.
Where there are legitimate variations in clinical opinions, informed consent becomes even more important. If patients share decisions about treatment they can better understand the differences in professional opinions.
In the Council’s experience concerns and complaints about oral health practitioners fall into one of three categories:
Competence – is the practitioner competent to practise?
Conduct – is the practitioner’s conduct appropriate?
Health – does the practitioner have a physical or mental health issue that adversely affects their fitness to practise?
Complaints can be referred to the Council by the HDC. When this happens, the Council will act promptly to decide what action should be taken. Council does not have any powers to award damages or costs, or to impose discipline. Discipline decisions are the preserve of the Health Practitioners Disciplinary Tribunal.
If competence is an issue, the Council will take appropriate action, including determining whether the practitioner poses a risk of serious harm to the public. Where that is the case, the Council has the power to restrict a practitioner’s scope of practice or suspend their registration on an interim basis during an investigation.
No action can be taken on a conduct issue while the Commissioner is considering it. However, if a conduct issue has been referred to the Council, it can order an investigation by a professional conduct committee.
If the issue is one of a practitioner’s physical or mental health, the Council will try to work with the practitioner to ensure their safe practice. The Council can require a practitioner to undergo medical assessments and, where appropriate, suspend their registration or place conditions on their scope of practice.