Dental Tribune UK Edition, October 25-3, 2010, No.26 Vol.4

care of a patient in pain chal- lenges many aspects of prac- tice management. Having an effective telephone system and appropriate staff available to answer the telephone promptly and effectively during surgery hours, with a caring and com- passionate telephone voice is certainly a good start. An ap- pointment system that can ac- commodate emergency patients at short notice is the next re- quirement, and will make it eas- ier for a receptionist to respond promptly and effectively to the patient’s needs. In this connection, it is im- portant to recognise the crucial role played by reception staff not only in making an emergency appointment, or offering appro- priate advice, but also in the way in which the patient is listened to and spoken to. Patients request- ing emergency treatment are, at best, being inconvenienced and, at worst, may be in severe pain or distress. Not uncommonly, the patient may not have slept because of their dental problem, and any response needs to take these factors into account. What is an emergency? There is a wide spectrum of opinion as to what consti- tutes an ‘emergency’. The ob- vious examples are a patient in acute pain, or with an ab- scess, or swelling, or exces- sive postoperative bleeding. It must also include the shocked and distressed child who has parted company not only with a skateboard or bicycle, but also with one or more teeth. All of these are situations where few would disagree that a dentist’s duty of care extends to seeing these patients without delay. Views differ, however, on the sore spot beneath the denture, or the loose crown, or the lost fill- ing which is symptomless. Some practitioners may be perfectly willing to see such patients with such complaints at short no- tice during surgery hours, but will be unimpressed if they are called out at a weekend or late in an evening in such situations. Most practices will have certain individual patients who tend to abuse emergency arrange- ments, for reasons of personal convenience rather than genu- ine need, and it is easy for these patients to influence a practice’s attitude to emergencies. It is important not to allow expe- riences with such patients to prejudice the response to oth- er patients who genuinely need emergency care, because it is not always going to be possible to provide this emergency care personally. Cover Arrangments Dentists will normally put in place some kind of emergency cover arrangements for periods of holiday, sickness or other ab- sence. This may take the form of a colleague within the same practice, or perhaps someone in another local practice where cover is provided on a recipro- cal basis. Emergency rotas are common, whereby a number of dentists in one area join forces to provide out of hours cover on a rota basis. Other dentists – particularly those in isolated or rural areas – will sometimes prefer to make their own arrangements wher- ever possible. In some areas, a local hospital or other clinic can provide a readily available addi- tional level of cover for patients, while in other areas there is no such backup, within a reason- able distance of the surgery. A sympathetic team It may not always be possible (or even, necessary) for the patient to speak to the dentist immedi- ately, and here the experience and knowledge of the person answering the telephone should allow him/her to assess the se- verity and possible causes of the patient’s pain. If it is necessary for the dentist to ring the patient back, make realistic and achiev- able promises of when this will be possible – and ensure that those promises are kept. Time passes very slowly for patients in pain, while perceptions of aban- donment and feelings of anger develop surprisingly quickly. Every effort should be made to convey a supportive, caring, compassionate and sympathetic response thereby transmitting the feeling that the practice team has understood the problem and are doing their very best to re- solve it as quickly as possible for the patient. Refusals cause complaints A patient’s request for emer- gency treatment is a situation that has a significant potential to create dento-legal problems. In most cases it is a perceived lack of care or concern, per- haps compounded by a refusal (by the dentist, or by a mem- ber of staff) to see the patient, or the lack of emergency cover arrangements, that causes the complaint. Sometimes the prob- lem arises from the treatment actually provided; perhaps as a direct result of the fact that time has to be created at short notice, when in reality no time is avail- able, and any treatment is done within tight time constraints. A refusal to see a patient who is in pain or bleeding heav- ily, or a tearful child can lead to an emotional response: simi- larly with a traumatic injury or someone with an acute abscess with a rapidly worsening swell- ing. The patient who is turned away may feel they have been let down and treated without care and consideration. In such cas- es expressions of genuine anger and resentment are not unusual. Sometimes, the patient’s re- quest for emergency treatment is not related to pain or swelling at all; their emergency request is based on some imminent personal deadline. Having a crown re-cemented before go- ing on holiday the next day, or a filling replaced before getting married, or before an impor- tant business meeting, may not be an ‘emergency’ in the eyes of the dentist or members of staff, but it is an emergency as far as the patient is concerned. Refusing such a patient will provoke similar levels of resent- ment, anger and frustration. Systems The best approach to the prob- lem is to establish a clearly de- fined system for dealing with emergency patients. Like any system, you and other front-line members of the dental team will need some ‘house rules’ about what exactly constitutes an emergency, leaving some flex- ibility to assess other situations on their merits. The next stage is to design a structured system for accom- modating emergency patients both during surgery hours and (where necessary) out of hours, and then to communicate infor- mation about this system and how it works to all patients. In some practices, there is a pat- tern whereby more requests for emergency attention tend to be received at certain times of day, or on certain days of the week. Professional Commitment Most dentists show an admira- ble professional commitment to patients who have a reserved (pre-booked) appointment on a given day. But there will be oc- casions when, in order to ac- commodate a genuine emer- gency, these plans may need to be altered. Explaining this to a patient who will thereby be inconvenienced, will, if han- dled correctly and with sensi- tivity, be less problematic than trying to explain to a patient in severe pain why they must wait several hours before they can be seen. Any request for emergency treatment needs to be recorded in the patient’s notes (preferably indicating the time) together with a note of the response, ad- vice/treatment given, etc. If a receptionist offers times for the patient to attend, later that day, but the patient declines because they are too busy that afternoon and would prefer to come in the following morning, then all of this should be recorded in the patient’s notes. If the patient’s condition should happen to worsen overnight, then at least it can be demonstrated that this need not have happened, had the patient accepted the earlier appointments that had been of- fered to them. It is worthwhile keeping a ‘log’ or similar record of all calls taken when away from the prac- tice, so key details can be copied back onto the patient’s clinical notes at the first opportunity. Summary It is often overlooked what a positive impact upon practice goodwill can have by mak- ing a real effort to accommo- date emergency patients. Not surprisingly, many patients who are treated with care and consideration, and are accom- modated promptly when their need is greatest, will often be enduringly grateful; some will demonstrate their apprecia- tion by becoming the most vocal and enthusiastic ambassadors for the dentist concerned. Predictably enough, the re- verse is also true, and a failure to offer or provide emergency care can create, by association, a reputation for being uncaring, unprofessional or even arrogant and dismissive of patients’ needs. A complaint or claim that is fuelled by a patient’s anger and resentment, and often personal animosity towards a healthcare professional who was appar- ently prepared to leave them in pain or otherwise suffering, is not easily resolved. Patients who make such allegations are often prepared to pursue them with a crusading zeal, demonstrating a single-minded determination to prevent the same situation aris- ing from other patients. DT ‘Every effort should be made to convey a supportive, caring, compassionate and sympathetic response; transmitting the feel- ing that the team has understood the prob- lem and are doing their best to resolve it as quickly as possible for the patient.’ Patients in pain need to be handled with compassion About Dental Protection We are the world’s largest spe- cialist provider of dental profes- sional indemnity and risk manage- ment for the whole dental team. The articles in this series are based upon Dental Protection’s 100 years of experience, currently handling more than 8,000 cases for over 48,000 members in 70 Countries. Email que- rydent@mps.org.uk or visit www.de- talprotection.org 21EducationOctober 25-31, 2010United Kingdom Edition