Nigel Jones interviews Kevin Lewis about the reasons for dentists’ anxiety around complaints and litigation, and whether there is cause for optimism that this may change…
Anxiety about complaints and litigation is rife among the dental profession, according to the recent Confidence Monitor survey of more than 400 dentists. Whilst many may well have predicted these results, they do provide insight into just how deep these feelings run.
The survey was completed by both NHS and private dentists and showed the majority all have some level of anxiety in this area. In the case of NHS dentists, 95% of respondents said they were ‘anxious’, including 45% who felt ‘very anxious’.
In comparison, 67% of private dentists stated they felt ‘anxious’, including 27% who were very anxious. To explore these worrying findings more deeply, Nigel Jones, Sales and Marketing Director at Practice Plan, asked Kevin Lewis, former Dental Director of Dental Protection, for his thoughts on the results and what they indicate about the profession.
Nigel Jones (NJ): The majority of dentists, whether private or NHS, reported some level of anxiety about the risk of complaints/litigation – what are your thoughts on that Kevin?
Kevin Lewis (KL): Before answering this, it’s worth bearing in mind that the question conflates complaints and litigation together and respondents included dentists in Scotland. Plus it is well known that the UK is the dental (clinical negligence) litigation capital of the world – but I’d say it is the England and Wales experience that is driving this. Scotland has a completely different legal system and very little “no win-no fee” so litigation is not much of a problem for dentists there.
There are many well-identified reasons why there are more complaints per capita against dentists than against medical GPs, and many more than against hospital-based dentists. The scale of the difference is greater in England and Wales than most other developed countries in the world so it must be more than just the fact that money changes hands when many patients are visiting a dentist in the UK, but not when they visit a hospital or their medical GP. There is clearly something about the UK culture/environment that makes it different, and the complaints to the GDC’s Dental Complaints Service confirm that this problem exists in private dentistry as well as in the NHS.
Complaints are not all the same in terms of the anxiety they are likely to generate. A complaint voiced by a patient at the front desk is very different to a complaint sent to the GDC, or a negative/critical posting on a public online feedback portal like NHS Choices or Yelp.
Both anxiety and complacency are often misplaced and later found to be unjustified. Some dentists spend much of their time carrying out high-risk procedures on high-risk patients but they feel no anxiety at all, while other dentists are cautious and may be a lot more anxious, even though their heightened risk awareness probably makes them safer. It is as much about individual attitudes to risk as it is about NHS vs private.
NJ: Why do you think private dentists reported feeling less anxious than NHS dentists?
KL: It could be any number of things. Private dentists are just as exposed to complaints, GDC complaints and investigations, and litigation as NHS dentists. It is possible that they simply feel more able to manage the risks because they probably have more time and feel under less pressure, but it all depends on how they use that time.
There are pressures and constraints impacting upon dentists when providing NHS treatment, that won’t exist when working privately, and this could affect anxiety levels – but I sense that this is oversimplifying a much more complex picture.
There is a world of difference between feeling anxious when treating a particular patient in a particular situation, and feeling anxious in a general, holistic sense. The latter may result from feeling less in control of one’s professional future, or fears for what the future might hold. In this context such a finding is hardly surprising.
NJ: If private dentists are reporting lower feelings of anxiety, some in the NHS might think the answer is to move to private – but is it really as simple as that?
KL: It certainly isn’t. It may simply shift the focus of any anxiety from one thing to another. But there is a lot of evidence to show that changing the way one interacts with patients (and this does take more time, which is at a premium for most NHS dentists) does improve patient satisfaction levels and reduces the risk of complaints and litigation – even if things go wrong with the actual treatment. Understanding this and feeling more confident in being able to invest the time with patients, and to influence the course of events, will almost certainly reduce anxiety arising about the risk of complaints and litigation.
Some dentists experience a lot of anxiety when they are reducing their dependence upon the NHS and moving increasingly towards the private sector, but change of any kind is usually stressful and this is equally true of many other moments of transition or uncertainty in life. Status quo is less scary but is not always sensible.
NJ: Can you ever envisage a time where anxious dentists are in the minority?
KL: Not overnight, nor any time soon. A lot would need to change in the external environment and in the UK’s ‘blame and compensation’ culture. It is well known that you tend to get more litigation and people seeking refunds and compensation in other ways during times of economic difficulty and uncertainty. It is anyone’s guess what Brexit will mean and how long things will take to settle down.
But, let’s keep the faith. I am encouraged by things that are happening in some of the organisations at the centre of dentistry – the BDA and FGDP(UK) in particular – and there are genuine grounds for optimism. If we are to see an upswing in dentistry’s fortunes, and a resurgence of professional pride and sense of place, this is where it will come from.
NJ: Are there any measures dentists themselves can take for better peace of mind?
You can’t have peace of mind without first feeling a sense of security. I think it is all about feeling that you are in control of your own destiny rather than feeling that things are getting worse and you are powerless to influence events. The UDA system since 2006 has (as a matter of deliberately policy) shifted the control away from practitioners, and practice owners in NHS-dependent practices have lost many of the levers than most other businesses can use to stay afloat and steer a successful course.
In the private sector you do get many of these levers back, but it doesn’t make the waters any less choppy – the external environment is still very difficult – but you are less exposed to the worst of the storms and far more able to navigate a safe course for your practice.
The central dilemma is that dentists are highly trained, professional people. Others expect very high standards of them, and they mostly expect very high standards of themselves. Having to compromise your standards is not comfortable for professional people, and it hurts when you are trying to do your best in a deeply imperfect situation beyond your control, and all you seem to get is criticism and ever-increasing scrutiny and blame. The general consensus in the profession is that it has been getting worse, so it would be surprising if any survey did not confirm disillusionment and anxiety for the future.
“There is a huge value and potential in collective effort – if we all throw our weight behind one or more of the current initiatives which could help dentists to feel better about their profession and its future, we could make a massive difference.”
It is significant, I think, that so many of the survey’s respondents also seem to see no medium-term or long-term future in the NHS. But it goes deeper than that because many of them see no medium-term or long-term future in dentistry (or UK dentistry?) either, and would not recommend it as a career option to friends and family. It is worth noting that we are hearing sentiments of a similar nature from other professions – like medical GPs, junior doctors in the hospital sector, nursing and teaching.
Other surveys are suggesting that young professionals in all these sectors (including dentistry) are disillusioned to discover that things are not as they expected them to be when they made their career choice and embarked on many years of training and incurred sizeable student debt.
I suspect that within the survey’s respondents there will be a lot of dentists nearing the end of their career, who have concluded that the best years are behind them, and things won’t get any better soon enough to benefit them. All of this would be really disappointing. Caring, highly trained dentists and dental teams don’t deserve to be feeling like this.
The worst thing that dentists can do is to sit on their hands and play the victim. Feeling sorry for yourself doesn’t change things but starting to take steps – any steps – towards the future you want for yourself, is a great antidote to feelings of anxiety and helplessness. On your own you can soon feel vulnerable, exposed and powerless to influence events. But there is a huge value and potential in collective effort – if we all throw our weight behind one or more of the current initiatives which could help dentists to feel better about their profession and its future, we could make a massive difference.
If we all do nothing, 2018 will predictably be much the same as 2017. If we are lucky. But wouldn’t it be great if 2018 was the year when dentists started to feel more positive, confident and optimistic again?
About Kevin Lewis
Kevin Lewis was the Dental Director of Dental Protection from 1998 to 2006. He qualified from The London Hospital in 1971 and spent 20 years in full-time general dental practice, plus a further 10 years practising part time. His involvement in the dento-legal field began in 1989 as a member of the Board of Directors of Dental Protection, and he subsequently became a dento-legal adviser and a few years later, the Dental Director. Kevin writes and lectures regularly all over the world and continues to provide consultancy and advisory services to a variety of organisations in and around dentistry and healthcare. He is also a member of the Transition Board which is tasked with creating a new UK college for general dentistry.