Protect Yourself

• Lawsuits and Complaints

I am not going to give you legal advice. I am not an attorney, nor is the following is about what you should do when handling legal issues. You should consult your attorney about any specific case or risk management.

What I am going to talk about is common sense. Most lawsuits against doctors are from unhappy patients. But merely being unhappy is not what drives a patient file a lawsuit or complaint. It usually happens when a patient, besides being unsatisfied, is also upset and angry with you!

Although it is true that a patient may sue you when they think you did something wrong, most patients will not pursue legal action if the case is handled correctly by you and your office.

There are times that we can prevent legal action against us simply by effectively communicating with our patients. Some statistics show that over 90% of patients who would have won a case if they had sued their doctor, didn't file one.

For a long time we have been intimidated by the frivolous lawsuits that are filed against doctors. However the real numbers are not as bad as we may think. When you compare the actual number of mistakes made by doctors with the number of lawsuits filled against them, you realize the majority of people do not go to court every time they are unhappy about something.

In my opinion, and from my own experience, it is all about having good communication with your patients. If you explain everything to them, go over possible complications, are truthful, and most importantly if you take responsibility when something happens and try your best to correct a mistake, you probably won't ever end up in court.

Nonetheless, there are rare cases when someone comes to you already planning to sue you, even before you have started the work. In these cases, as long as you have an organized office and your paperwork and documentation are done correctly, you will most likely be fine.

Let's go over a few guidelines that will help you protect yourself:

1- Do not begin any dental work before checking the signatures on the consent form for the procedure that is being done yourself. You need to verify the date and correct tooth number. If your patient is a minor, you must know who is signing for them and make sure they are legal guardians of the minor. When you are working on a patient who speaks a different language, try to find a consent form in their language; if this is not possible, write down the name of the translator and have the translator sign the consent form as a witness. Make sure you record both peoples' names.

2- Ensure your consent form is in compliance with the latest standards and includes all the possible risks and complications. Your malpractice insurance company can be a good source for the most comprehensive consent forms.

3- Make sure your patient has signed the treatment plan for the procedure you are performing. As mentioned in the organized office section, everything in the office has to go through a double checkpoint before it comes in front of you. When it comes to consent and treatment plan signatures, I always check them MYSELF. You are the one who is ultimately responsible; no one is going to sue the staff member who forgot to get the consent signature but they will sue YOU, so check the signature yourself. As you know you should also sign the consent form after discussing it with the patient.

4- Record, record and record. A number of doctors have been forced to settle lawsuits, not because they did something wrong, but because they did not record what they did, at lease not correctly. Even if you call a patient ten times to follow up for a necessary treatment, if you fail to record it you may end up losing a case for patient abandonment! If you give a patient a prescription without documenting it, you may face trouble down the line if there are problems with drug interactions.

You and your staff need to meticulously record everything that happens in the office. Doing this not only makes it easier to follow up on different tasks, but also protects you against fraudulent claims ("They didn't call me..." or, "They never told me that..." etc).

5- Be understanding with unhappy patients. Even though they may be unreasonable at times, when it comes to your business you have to consider the ramification of getting into a confrontation. What benefit is it to you if your staff argues with a patient to prove him wrong, instead of trying to settle it in a respectful, professional manner?

Dentists and staff members often tell me, "We had to tell them or show them they were wrong, it is a matter of principle." What principle is this? It is certainly not a business principle!

Often times we are upset about something ourselves and as soon as a patient wants to be a little unreasonable, we can't take it anymore and we show them who they are dealing with! The attitude tends to be, "I didn't do anything wrong, let them do whatever they want!"

What we fail to recognize is that our patients have their own problems and most of the time it isn't really about us. A patient could be upset about something totally irrelevant to their treatment, such as the insurance, personal finances, family problems, work or a number of other things. They may simply be taking these frustrations out on you.

Now, you have two ways to handle this:

1. Be smart, calm the patient down, show them you are on their side and diligently make them realize you are not the real source of the problem. Let them know you are there to help.
2. Or do the opposite; be stubborn, make the situation worse, and create the perception that YOU are the main cause of their problem. This leads to other consequences such as losing that patient, losing possible referrals from him, facing complaints and  sometimes even legal actions against you.

When you follow the first option, once your patient has calmed down (maybe a day or two later) they realize they were upset about something else, and that although they were rude and aggressive towards you (and/or your staff) you were nice and professional. Over 90% of the time this makes them change their attitude.

I can tell you that in my office we turn over 95% of our unhappy patients into loyal and active patients, most of whom refer family and friends to us. They appreciate the fact that we were trying to help them, even when they were not very friendly!

Now I know there will be times when you face people who simply don't want to work with you. Even in these cases, you can escape their abuse by maintaining a professional attitude. The question is how often does this happen to you? Once a week, once a month, every day?

What I tell my staff is that they should not have to encounter a situation they can't handle more than once every two to three months (in a busy practice). When these circumstances arises, I get involved.

I don't remember the last time I had a patient who was unhappy about something, and who I was unable to reason with. During the past three years we had only one patient who would just not understand what we were trying to explain to her.

I personally advised her that maybe her best option would be to get a second opinion, because it seemed we could not communicate very well. I also explained how we want our patients to feel 100% comfortable with the treatment plan they choose to follow.

She took my advice, but two months later she came back apologizing about her behavior and asking us to accept her as our patient again!

The most important tool in dealing with an unhappy patient is acknowledgement. No matter how poor the choice of words on the patients part, you must try your best to put yourself in their position. Look for the underlying reason for the patient’s anger.

Frequently I have noticed that when a patient is complaining to us about something, the real issue is something else entirely. For example, I had one patient who was a mom and was extremely upset because she claim that we did not call them to follow up with her daughter's treatment plan.

As we always do, we first acknowledged that we were sorry our patient was less than happy. We then asked her if she would kindly allow us to look into the matter and get back to her by a certain time (preferably the following day).

The emphasis at this point is to calm your patients down and assure them that you will find the source of their problem and take care of it to their satisfaction.

This will give you some time to look into the matter, and will also prevent the situation from escalating.  Going back to the example, when we looked into the issue we discovered that we had called the patient’s house and left several messages with the husband. What we didn't know was that the couple was in the middle of a very difficult divorce and none of the messages ever got to the mom.

Understanding the delicacy of the issue, we called the patient the next day. Without having a "we were right" attitude, we nicely explained that we had called their house for follow ups and since we were unaware of the situation, we did not know that we should have called the mom directly; we apologized for that!

Now, I know we were right and that the patient had no right to yell at us when the problem was rooted in her own household, but instead of having a victorious tone of voice, smartly, we realized the sadness of the situation.

We put ourselves in her shoes in an effort to feel the frustration she felt. Knowing this was not our fault, what we realized was that proving her wrong had absolutely no benefit to us. It would be a worthless argument, and would only serve to worsen the situation thus resulting in a hostile patient. Now imagine having a failed root canal treatment (because of a broken instrument) in such a patient's mouth!

If you were upset about something in your life, then went to a dental office and complained about something and everyone attacked you and implied you are an idiot for not having control over your life, would you not want to do something to that office? Imagine hearing that excuse when you find out they broke an instrument in your tooth and did not tell you about it!

You may not be able to prevent every possible legal action against you, but you certainly can reduce your risk by doing the following:

1. Record everything.
2. Check the important signatures yourself.
3. Looking over the medical history and update it every time.
4. Do not turn an upset patient into your enemy; calm them down and be understanding, even if they are out of line.
5. Have a system in place so that every administrative procedure is checked by two people.
   

• Embezzlement

Embezzlement is much more common than you may think. Fortunately for our practice it happened to us in our very first year. It truly opened our eyes to the reality of life.

The one who did it was the person we least expected would ever so such a thing. Thanks to our checking systems we were able to catch this person only two weeks after she had started!

Let me tell you more about what happened, because I believe you can learn a lot from the details of this case.

A few weeks before we learned this was going on, we were desperately looking for an office manager. It was at the time when I still thought bringing in an office manager from outside was a very good idea.

After looking for a while we interviewed an applicant who had just moved from another state and seemed perfect. She was experienced, had been running an office for many years, was very professional, and had great communication skills.

We hired her, and she took over in a matter of days. It was working out so well that I told many of my friends I had found exactly what I was looking for. Every time we had an issue, she would volunteer to take care of it. To put it simply, she seemed too good to be true!

As I mentioned before, in our office everything is checked by at least two people. When it comes to finances, it is checked by three people. The thing is, one of these checks is done without the knowledge of the others; that was how she got caught.

She was a professional! She took cash, patients' checks, and even took insurance checks! Then a team of people would cash these checks for her! She would do this mostly with patients who were emergency patients or people with shorter treatment plans, so we were less likely to find out through follow-ups.

Next she would delete all the records for these patients and destroy their charts!! When we found out we fired her immediately and eventually recovered all of the money she had stolen.

I know of dentists who had people stealing from them for years, and did not find out until months after the person had left the office! One thing that a lot of embezzlers do is destroy or change your records. This way they are not billing the insurance, therefore reducing the chance of getting caught! Consequently, the loss is twofold what they take and what you lose by not billing the insurance.

Another important factor to note is that the people who do this usually appear to be your best staff member; the one who stays longer, is the nicest to patients and never complains! This means you cannot assume honesty solely based on appearance. There is no way to really classify the "type of people" who do this, which is why it is imperative you setup your system so that it is difficult for dishonest characters to function, and easy for you to catch them if they do.

This is how:

1- At least three people should be responsible for going over patients’ charges and accounts.

Here how we do it:

When a patient comes to the office and their treatment plan is ready, the front office (or office manager) calculates the fees that should be paid and gives the information to the treatment coordinator. The treatment coordinator then presents the treatment plan; he is responsible for making sure the funds are paid at the time of or before a treatment is rendered. When billing insurance, there is a third person who enters the information and payments come from insurance into the computer.

With this system, in order for a staff member to steal money or take a check for himself, he has to arrange it with the other two people!

Another rule in our office is that any money, checks or credit card receipts received must be immediately taken to our back office and placed in a certain box. Even a five minute delay is dealt with in a serious manner. There is a zero tolerance policy on this and everybody knows that all forms of payment have to be taken to the back office as soon as they are collected, regardless of how busy the person receiving the payment may be.

This significantly minimizes the amount of time staff has access to funds, therefore eliminating any temptations or opportunities to a great extent.

Since everything is entered into the computer right away, and the staff doesn't have the authority to delete information from the digital chart (limited by the software), it is virtually impossible to take anything without creating a discrepancy in the transaction! Remember, at the end of each day there are certain reports that your personnel have to give you; this makes it very difficult to conduct less than honest activities without being noticed.

2- If you can (and if the law in your state allows) I suggest you run a background check on your new applicants and even your existing staff if you have not done so. There are now a number of companies on the internet that can do this.

3- Never trust a person in your business to handle 100% of your finances, even if he/she is a relative. I am not saying that you should doubt everyone, just have a  secure system. Running a one-person show is not secure. No matter how long a person has worked for you, always accept the possibility that "it" could happen to you.

If the contrary is proven, then good for you and your trustworthy staff. I can't tell you how many dentists have incurred losses into the hundreds of thousands of dollars from their most trusted staff member. The sad thing is, most of them did not find out until years after that person was gone!

You have worked very hard to get where you are. Don't let a preventable mistake ruin your practice and your future.

• Be honest and expect honesty.
• Supervise all aspects of your business yourself.
• Have necessary insurance coverage in place and active at all times (malpractice, disability, business liability, etc).
• Enjoy practicing dentistry with the peace of mind that your practice is safe and secure.