Dealing with testing patients

25 May, 2015 / clinical

When a treatment plan does not meet the expectations of a client, what are the options? Sometimes, the best solution may be to offer a refund

In 2013, Mr C saw a 35-year-old female patient – Miss P – for the first time when the patient attended seeking an aesthetic solution for her stained upper central incisors. The patient gave Mr C a photograph taken in her teens and asked if he could provide restorations to reproduce the former appearance of the teeth.

On examination, the patient’s oral hygiene was fair with a BPE of 001/120. The incisal edges of all incisors showed some signs of acid erosion and attrition and moderately sized composite restorations were present. After taking study casts and radiographs, a treatment plan was drawn up involving the placement of six anterior veneers and some routine periodontal treatment.

The patient then signed her treatment plan to indicate her consent before the treatment commenced. During the wax-up stage, the patient became increasingly demanding and several modifications were required before the dentist felt able to have the veneers finished.

The first time that the veneers were tried in position, the patient was unhappy with the length and she asked for adjustment. At the second appointment, the veneers were cemented, complying with the patient’s wishes. Within hours, the patient returned, demanding their replacement because the spacing was incorrect and they looked uneven. Mr C agreed to replace the veneers, but felt there would be insufficient enamel to guarantee good adhesion. He recommended all six be replaced with crowns.

After removing the veneers, he re-prepared the teeth, took impressions and sent these to the laboratory, fitting temporary crowns in the interim.

The patient insisted in overseeing the making of the crowns and wanted to speak to the technician. It was agreed that she could go to the laboratory, which was close by the surgery, to explain what she wanted. After the crowns were made and fitted, the patient seemed quite pleased with them. However, she phoned a week later complaining they had not been made to her specification and they were interfering with her speech and causing discomfort when eating. In addition, her gums were bleeding.

Mr C was determined to refute her complaint. However, within days he received a letter of complaint informing him that she was going to a solicitor to seek compensation. When Mr C contacted Dental Protection, he was asked if there were any aspects of the treatment about which he would not be confident. After examination of the available clinical photographs, it was apparent that the crowns were a little bulky with signs of inflammation and bleeding at the gingival margins.

Mr C was advised that he still had the option of offering a refund at that stage. Alternatively, he could refer the patient to a restorative consultant at the local hospital for a second opinion. Mr C contacted the patient offering her either a straightforward refund or a referral to the specialist.

The patient wanted to negotiate the offer, saying that she would accept the refund, but wanted the dentist to contact his insurers for £3,500 compensation for pain, suffering and time spent attending the practice for remakes etc.

After several exchanges of letters, there was little option but to suggest that the patient allow Dental Protection to contact her directly. She was made aware that, as part of the process of determining the merits of her claim, she might be asked to attend an independent practitioner for an opinion.

The patient initially agreed to Dental Protection contacting her but, two days later, she phoned to accept the refund as a way of resolving the matter. She refused to confirm this in writing and was simply expecting to pick up a cheque from the dentist. As Miss P was prone to changing her mind, Mr C was reluctant to refund the money until he had a signed document of agreement. Dental Protection agreed to assist him in wording the document and, after a further delay, the patient eventually agreed and signed the document.


• If there are any weaknesses in the consent process or clinical care, consider offering a refund.
• Dental Protection may advise, in some cases, that patients demanding compensation should be dealt with directly by one of the in-house team. This can reduce the involvement of the member and avoids the additional legal expense of a patient contacting a solicitor.
• Dental Protection will not always advise the use of a written agreement as this can sometimes drive the patient to instruct a lawyer. However, agreements can be useful in some circumstances.
• The quickest way for a patient to seek a resolution is to ask a practitioner to refund the appropriate fee.

Tags: client expectations / difficult patients / offering a refund / treatment plan

Categories: Magazine

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