A Case Study on Patient Communication

One important factor leading to a breakdown in communication is emotion. Negative emotions channeled into negative outcomes directly relates to the communication climate between patient and provider. For example, analysts note that during Advice Line calls, dentists often express the feeling that patient complaints are simply an attempt to avoid payment for their services. Negative emotions based on this assumption may cause the dentist to fail to investigate if there are legitimate reasons why the patient is unhappy. The patient making the complaint in consequence feels unheard and increasingly dissatisfied, building upon the negative emotions and further breaking down the communication.

In one case reported to TDIC, a minor patient developed an abscess on tooth No. 7 while undergoing orthodontic treatment. The orthodontist’s office received an unpleasant phone call from the patient’s mother who requested to speak with the dentist. She reported that her child was complaining of discomfort on a front tooth and their general dentist had provided them with a referral to an endodontist to determine the source of the patient’s symptoms. The mother believed the abscess resulted from tooth movement during the orthodontic treatment and demanded a copy of the patient’s records, including radiographs and models. In looking at the pretreatment radiographs taken two years prior, the orthodontist noted evidence of a slight periapical radiolucency on No. 7. Given this finding, the orthodontist said they would have referred the patient to an endodontist then for further evaluation. The orthodontist was uncertain whether the extent of the treatment or the treatment outcome had been impacted by the delayed referral and diagnosis. Concerned about how to communicate this finding with the mother, the orthodontist reached out to TDIC’s Risk Management Advice Line for guidance.

The Risk Management analyst reminded the orthodontist of the importance of reviewing pretreatment records prior to initiating any treatment and to establish protocols for conducting a comprehensive assessment of the pretreatment records gathered while developing a treatment plan. To facilitate positive communication with a concerned parent, the analyst advised the orthodontist to return the mother’s phone call without any further delay to explain his findings in a transparent manner. The dentist was additionally counseled to seek permission from the patient’s mother to speak with the endodontist to determine whether the prognosis would have been different had the issue been caught two years earlier when it first appeared on the radiographs. The analyst offered the dentist de-escalation tips and reiterated the importance of listening and remaining empathetic. She alerted the dentist that the mother could potentially interpret any minimization of the patient’s symptoms or necessary treatment as being dismissive of her concerns about the prognosis for her son’s tooth. continued on page 4 continued from page 3

A few days later, the Advice Line received a followup phone call from the orthodontist, reporting that the guidance he had received from the analyst was helpful and the conversation with the patient’s mother went much better than he anticipated. The dentist explained to the patient’s mother that he had reached out to the endodontist and the endodontist confirmed there were no changes in the prognosis or the extent of treatment needed despite the timing of diagnosing the radiolucency. The mother seemed to be receptive of the explanation the orthodontist provided to her and was reassured that the overall prognosis for tooth No. 7 was favorable.

In this case, the orthodontist’s transparency about treatment and involvement in the treatment plan effectively communicated his concern for the well-being of the patient, diffusing a difficult situation.