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Put it on a video
In the 1980s, recognizing that audio-visuals were the finest teaching tools, we created a series of 2- to 3-minute informed consent videos (ICV) that frankly reveal possible consequences of a root canal filling, surgical event, denture or crown and bridge procedure. Professional liability experts edited the information, which is concise, consistent and delivered in plain English.
The video relates the bad news of potential unfortunate happenings—a file may go through a root canal, a dry socket might occur, a bridge does not last forever, half the success of a new denture rests with the patient and so on.

Patients must watch the video before we perform the procedure, and then both the chairside assistant and the dentist ask if they have any questions. When their questions are answered, we ask them to sign that they saw the video, understood it and that their questions were answered. Their signature is then scanned into their computerized chart.

During the past 23 years, 17 lawyers have sent our doctors those ominous letters. After reading the script of our short ICVs, all 17 lawyers faded into the sunset. We did not even call our insurer to report the incidents.
If 17 sounds like a large number of legal inquiries, understand that our office has 34 chairs, a staff of 55, three or more doctors, 12 hygienists and 250 to 300 patient visits daily.

It’s not always about winning
There’s one more step in the dissatisfied patient scenario—defusing the situation. Dissatisfied patients, if they do not simply walk, often will settle for an admission that we were wrong. But we don’t give in easily. Our combative instincts have programmed us to roll up our sleeves for the fight. And that attitude breeds danger.

I speak from experience. In my early years of practice, when patients had problems with my services, I fought to prove them wrong. In some cases I won and felt vindicated. More often I reached a stalemate, or I lost.
In time, I realized that trying to tame an upset patient was futile, both financially and emotionally, and it was a waste of time. I had to ask myself, if I won, just what had I won?

Talk it out
As my eyes opened to a smarter way to deal with patient adversaries, I invited them to sit with me and I asked: “What is the problem and what would you like me to do about it?”

Amazingly, some just said they wanted me to know about the problem. I assured them I would look into it and correct whatever was needed in a delivery system that had let them down. And I never failed to follow through on that promise.

Some dissatisfied patients wanted a refund, a remake, a different treatment option or even another doctor. We promptly gave them whatever they wanted and we bore the cost. Many felt we handled the remake situation well and remained as patients.
That solution costs far less than paying lawyers, and we wasted no time arguing, stewing or negotiating. The methodology is to defuse the patient’s discontent by resolving the complaint.

Despite our best efforts, a few disgruntled patients still wanted a pound of flesh. We gave them a brochure we had prepared that explained their rights under the AAA program. But in the vast majority of cases, managing a patient’s expectations realistically was a wise strategy with positive results.

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