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I&I Interview: Dr Elaine Mo
Elaine Mo, a general dentist in private practice who graduated in 2012, talks to me about making the shift from student to dentist, including her experience of receiving and dealing with complaints. As well as being a dentist, Elaine is UK National Director and Central London Director for Dentinal Tubules and sits on the British Academy of Aesthetic Dentistry (BAAD) committee. In this interview she also shares her advice for managing complaints and the importance of choosing the right indemnity provider.
As a relatively recent graduate, how did the reality of being a dentist match up to any expectations you had beforehand?
It was completely different to what I expected! As an undergraduate you’re very protected, and it’s totally different to real life dentistry.
I feel very sorry for final year students, particularly this year’s cohort who are dealing with the pandemic as well, as the funding cuts that were evident when I was graduating eight years ago are continuing to get worse. This means that dental graduates are getting less and less experience compared to our colleagues 20 years ago and often feel less prepared when they move into the outside world of dentistry.
Dental school is there for making you into a safe dentist, not necessarily the best dentist or the best all round dentist. All the new techniques and really cool things you see on social media, you learn after you graduate by focusing on your own personal development and through experience.
As a dental student you’re not really taught what’s happening in the NHS and about UDAs, or about how to manage patient expectations or just how to manage people in general.
We’re taught clinically how to do a filling or a crown prep at each stage, but behind that treatment is a person and we’re not taught about what their expectations might be. In this litigious day and age, we need to be taught the art of managing people.
My parents were restaurant owners, so I grew up around the hospitality industry and I think that kind of customer service perspective is what a lot of people in dentistry are missing.
But a good patient journey is what is going to protect you. If your patients get on with you, they will appreciate that sometimes mistakes are made as well as any attempts you make to rectify it, and it probably won’t lead to anything bigger.
Do you think dentists are adequately prepared as students for handling complaints and the threat of litigation, both practically and when it comes to the effect on their mental health?
I don’t think anyone at any point in their career can be prepared for complaints. They just happen and we have to deal with it.
We’re there to treat people, and to satisfy them. But often we feel obliged to take on patients that we know are troubling and that we’re not going to get on with.
One of the things that’s neglected in dental school is communication and knowing when it is ok to step back from a patient and not treat them.
It’s about taking your time to identify what the patient is like and whether you are a good fit for each other. But that is a major issue, especially in the NHS sector when there is time pressure to meet targets that generally means you don’t get to build that rapport with your patients.
When I graduated, I felt as if I had to treat everyone, including patients I didn’t like. Every dentist has been there, we all know that unfortunately some people will never be satisfied.
While a complaint can come at any time from anyone, if you are confident to only treat people you feel you can form a bond with, the likelihood of receiving a complaint will reduce.
It’s also really important to have a supportive network around you. Fortunately, there are a lot of online groups and platforms for dentists with people who are happy to share their advice and often just hearing that others have been through the same issue can be reassuring.
We all hear scare stories about a small thing that ends up as a case with the GDC. As our regulator, if they get a complaint, they have to look into it, that’s their job and there’s not much you can do about it at that point.
But it can take a long time for a case to be resolved and that can be very stressful. Being mentally prepared for such things is something not a lot of people talk about. We have lots of courses on how to do a filling but none about how to do self-care.
Do you think there is an issue with defensive dentistry being seen as the path of least resistance in a litigious society?
Defensive dentistry is happening more and more because people are scared of the potential repercussions that many are no longer doing certain treatments. Hospitals are receiving more referrals and their limited capacity is becoming even more stretched.
Of course, if something is out of your realm, and you’re going to struggle and become stressed about it, then you should refer it on.
However, when that becomes the regular default position, you end up with clinicians who aren’t doing root canals or extractions, they’re only doing routine check-ups, and therefore they become less skilled; if you haven’t performed a root canal for six to nine months, you’re going to lose that skill.
I think the key is to identify what you enjoy doing, what you want to do and what you don’t want to do and focus on that, particularly when it comes to post-graduate courses.
Patients don’t necessarily understand how complex certain treatments are. One of the reasons they can become annoyed is when they’re being told they need to have a tooth taken out but they have friends and family who have had similar issues and had their tooth saved.
The key, as is so often the case, is communicating well and setting their expectations. I don’t think we’re explaining well enough to patients about what we do and what dentistry is.
I will show my patients the file I need to use for their treatment, and when they see how small it is, they begin to understand how complex it is.
If we start explaining better what is involved in the treatment, I think that will naturally lead to less complaints because patients start to appreciate that if something does go wrong, it’s not necessarily the dentist’s fault, it’s because it’s a complex procedure.
I also tell my patients ‘There’s no such thing as a permanent filling or implant, what we do is buy you some time, which could be one year or ten, and that will depend on what tooth structure we have to start with and how good or bad the foundations are to work with’.
When you put it like that, patients understand better that there’s a chance it may fail down the line, and again, if that does happen, they’re less likely to complain or sue.
Have you had personal experience of dealing with complaints that you’d be happy to share?
I had a couple of minor complaints, which luckily never escalated anywhere, when I was doing NHS dentistry in a mixed practice within a couple of years of graduating.
One was due to a root breaking off from a tooth during an extraction which led to us referring out to a hospital, who then had to delay the treatment. The patient wasn’t happy about this and sent in a letter.
The practice replied according to our complaints policy and I contacted my indemnity provider.
The second complaint was not a clinical issue, it was concerned with fees that the patient wasn’t aware of.
When you do receive a complaint – which you will, if you don’t then you’re not doing enough dentistry – you need to understand what the patient wants as a result of making it.
Receiving a complaint is disheartening, but the best way of dealing with it is to learn something for the future. I learned from my experiences that transparency with patients is really important.
Of course, you should deal with a complaint on a practical level, in terms of contacting your indemnity provider and acting in accordance with your practice’s protocol, but you can also deal with it on a personal level.
By which I mean, reflecting on what happened, what you could have done better and what you’re going to change in the future to make sure it doesn’t happen again.
For me, I decided I was rushing too much in order to meet targets, so I moved into private practice. From there I became much more interested in building my own patient journey, learning more about my patients on a personal level, concentrating on how it feels to be a patient and how to become a great practice, rather than a standard one.
My complaints came from not taking enough time to identify with my patients and explain things clearly.
I learned that we need to educate patients better and put some onus for dental health on them, which becomes easier the more time you have to talk to them about their responsibilities for their teeth and oral health.
In private practice I also have greater ability to choose who I see as a patient. There are very few patients I would turn away, but if my gut feeling isn’t happy then I know I have that option; it’s much more difficult to do that in the NHS.
No one can get on with everyone, so it’s not something to take to heart – but that can be hard to get used to, especially as a new dentist. You just have to learn to get over the idea that you can please everyone.
What advice do you have for someone at the start of their dental career about how to handle a complaint so that it doesn’t escalate?
If you handle a complaint well, most of the time it will go no further than the practice.
Firstly, if you get a complaint, you should contact your indemnity provider.
If you are a very recent graduate and still on your VT scheme, hopefully you have a supportive trainer or principal dentist at your practice that you can speak to.
I would always offer the patient who made the complaint the opportunity to come and see me about it. They may have sent off the letter or called just because they were already having a bad day and the fact that they then got a toothache just made it worse.
If they were just having a bad day, if they come in and you chat about what the problem is and what you can do going forward, that may well be the end of the complaint because, you showed that you care.
The worst thing you can do is ignore it.
If you can show that you care about the patient and want to help them, such as by rectifying the problem free of charge or offering a refund, they will be satisfied with that outcome, although sometimes offering a refund can be a bitter pill to swallow if you’ve not done anything wrong. Indemnity is there for that kind of advice as well!
And there’s nothing wrong with saying ‘I don’t think I’m the right dentist for you, let’s find you someone more suitable’ or getting a second opinion.
If a second or third dentist agrees with you that the reason for the complaint was simply a complication or something that was difficult to treat, a patient will normally accept that.
What’s your experience of finding appropriate indemnity and working with indemnity providers?
When I first graduated, most people generally just chose whichever indemnity company had visited to talk to their dental school!
We really didn’t know much about it except that you need it, so you just got a policy and expect that you’ll be fine.
As you get more experienced, you realise how important it is and that there are more providers out there than you first realised.
I didn’t know for years that my indemnity was provided on a discretionary basis. Since then, I’ve moved to an insurance-based provider. When insurance-based providers first arrived on the market, people were a bit wary because it was a new concept, but now they’ve become really popular and I think they’ve become the go-to providers now.
It’s been a few years since I took out an insurance-based policy and I’ve stuck with it because I feel more comfortable that they will definitely be there for me if I needed them.
What I didn’t understand was all the different levels and types of cover. I branched out into facial aesthetics and I had to figure out what kind of cover I needed for that, on top of what I already had in place.
My advice is, find out what is suitable for the specific kind of dentistry you’ll be doing, and if this changes, make sure you’re still covered. A recent example of this is that dentists who have been fit testing their teams for PPE during the pandemic have needed to secure additional cover for that.
A lot of people just choose a provider they’ve heard of, but you really need to look at the finer details. Don’t just look at the price – if you choose a cheaper provider but they don’t cover everything you do, you may end up needing to buy additional policies, so it’s a false economy.
Look into it properly, compare it properly and make sure it’s suitable for your needs.
On that note – if you want to begin comparing dental indemnity providers and policies, we have gathered everything you need in one place.
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