Patterns

By Aaron Stevens, DMD

When you love your children, you want the best for them. You want to help them succeed and avoid the rougher things in life. In that endeavor, while teaching my brilliant teenagers, there is a recurring theme of “if you do (insert wise course of action), you can avoid (insert unpleasant experience).”

I was recently asked by a fellow dentist about trends and how to “avoid DQAC cases”.

I don’t have hard data on trends, but I do have lessons from what I’ve experienced. Having a DQAC case can be stressful and unpleasant (I’ve had one myself and investigated hundreds), and nothing would make me happier than to help dentists avoid the need for an investigation. DQAC is a complaint driven entity. The principal source is patients, but we also get them from the national practitioner databank which reports civil case settlements as well as other state’s disciplining authority. Though there are no guarantees of avoiding an investigation (anyone can complain at any time), here are patterns I’ve seen that may help you reduce the risk of your own investigation:

• People complain when they are angry or if they feel deceived. Be upfront about risks and make sure to under-promise and over-deliver. Documenting the risks in such a way that the patient knows it is in their chart is a great way to avoid the “you didn’t tell me” issue. I dictate a lot of my notes to my assistant to type in while the patient is in the chair. Be very clear about costs and potential changes to the procedure Information before the procedure is “information.” Information after the procedure is an excuse. If things don’t go well, being reasonably liberal with an apology and a refund would drastically reduce the number of cases.

• Complainants aren’t only patients. Disgruntled staff (and ex-spouses) are especially effective complainants. They know you well and the areas where you aren’t as good as you should be. They have access and inside information. They can point things out or even create problems for which you are then responsible. 

• Cases that involve more money are more likely to be investigated or end up in a civil case. If you engage in high-cost cases, you should pick ones that have predictable outcomes.

• Red-flag patients usually show signs of being such. If that Spidey-sense starts tingling, back away. Find a way out. Refer them to your favorite colleague.

• Be kind and respectful to everyone, regardless of what they do. This doesn’t mean skimping on boundaries, but how you do it matters. Besides being the right thing to do, you’ll feel better too. If you are kind and respectful, it can help your staff back you up if investigations happen.

• Document well enough in your charts that someone (in our profession could understand clearly what happened. Good documentation helps those auditing or investigating to understand why you did what you did. Write a thorough and easy-to-follow PARQ summary and SOAP notes. Include details of the thorough risk/benefit discussion with the patient. Include which of the presented options the patient chose.

• Stay current on the laws that govern the profession. Stuff changes. Please keep up. It is possible to do everything right and still get complaints (if you have a spouse, kids, or in-laws, you already know this). But, if you do these things well, you can reduce your chance of going through what can be a stressful DQAC investigation.