A stitch in time saves nine: insights and reflections into complaint handling

This blog, A stitch in time saves nine: insights and reflections into complaint handling, is part of a series to support your learning and encourage good practice and continuous improvement to achieve positive patient outcomes.

The quest for technical excellence in dentistry and the constant pursuit of perfection can create vulnerability. For some dental professionals, when a patient/or their representative expresses dissatisfaction or an unexpected outcome arises, feelings of self-doubt, anxiety, defensiveness, or a sense of (professional) failure may be triggered. Yet complaints and concerns are not necessarily evidence of inadequate clinical ability. They are, however, an inevitable consequence of delivering healthcare in a complex, often high-paced, and increasingly consumer orientated environment.

As a clinical adviser reviewing Fitness to Practise (FtP) cases, I see how patient complaints arise, escalate, and develop into regulatory matters. Often, there is a missed or failed opportunity to resolve issues locally, or in a prompt and effective way, not having or not following a complaints process. These cases offer valuable opportunities for reflection and learning. Looking at a complaint objectively, through the view of the complainant may also be helpful.

In this blog I will share some of these insights and discuss how a different approach could have made a difference. The examples used are fictitious but inspired by true cases.

The perfectionist trap

Dentistry often attracts high achievers. Individuals typically enter a culture that reinforces the belief that mistakes must be avoided and should not happen. Yet the reality of clinical practice is far more nuanced. Biological responses to treatment interventions vary, patients differ, and their expectations and reactions can be divergent. None of these variables can ever be consistently predicted or controlled with absolute certainty. Real-world dentistry will never perfectly reflect the predictable outcomes seen when working in simulation suites.

When a complaint arises, this perfectionist mindset can trigger internal thoughts such as:

• I should have done better.
• Why has the complaint been made?
• This should not have happened.
• What if this becomes something more serious?

These reactions are entirely human. Dental professionals may momentarily feel shell-shocked and less confident about addressing the complaints openly. Instead, the initial instinct may be to defend, justify, withdraw, or react.

One of the recurring themes in FtP work is that many complaints do not arise from significant clinical failings. More often, they stem from:

• Communication gaps and timekeeping.
• Misunderstandings (especially NHS or private) and with fees.
• Mismatched expectations.
• Perceived lack of empathy or respect.

Dissatisfaction may be conveyed verbally, non-verbally, or through formal complaints, and clinical advisers review the resulting correspondence. Clear patterns of poor communication and inadequate complaint handling are commonly seen.

Understanding how dissatisfaction develops into a formal complaint is important in preventing escalation. It typically begins with a trigger event - an unexpected outcome, perceived harm, or feeling disrespected. The patient then interprets the event, often through the lens of hindsight, emotion, or anxiety. If their complaints go unacknowledged, these emotions can intensify. Social reinforcement may follow, with family, friends, or online communities encouraging them to ‘take it further,’ and this may be supported using social media, the internet and/or AI. At this point, the individual stops feeling like a patient and starts feeling like someone seeking justice. This may prompt escalation to a regulator or a legal challenge.

Many patients who lodge concerns with us, commonly describe experiences such as:

• “No one listened to me.”
• “I felt dismissed.”
• “No one explained what was happening.”

Example A illustrates the progression of a complaint and where the poor use of soft skills/and communication compounded the sense of injustice. A frustrated dentist hurled a lower complete denture across the room, shattering it against a wall. This outburst followed several consecutive days of denture adjustment appointments for an elderly patient who continued to find the ‘Rolls-Royce’ denture uncomfortable. During the last encounter, the patient raised their voice, grabbed the dentist’s hand, and made disparaging remarks about their competence, suggesting that their dental-student grandson could have ‘made a better ‘job of it!’ In that moment of anger, the unsettled dentist subsequently placed the broken denture in a plastic bag and returned it,’ adding, “I’d like to see if your grandson, or anyone else, can do better.”

The patient and their grandson then telephoned the practice several times, asking to speak to the dentist, also seeking a refund. These calls were ignored by the dentist, and they were told by the receptionist to put their complaint in writing. The grandson then escalated the matter to the GDC, bypassing local resolution, also raising concerns about the safety of vulnerable elderly patients and the dentist’s conduct.

The above case stresses the importance of remaining professional, objective, and calm - even under provocation. A prompt and sincere apology, alongside a discussion about options such as referral or a refund might have prevented escalation. Avoiding issues by cancelling appointments, postponing reviews, or ignoring calls never resolves the problem, and in this case, the window of opportunity for local resolution was closed. Silence magnified the complainant’s emotions, allowing frustration to turn into betrayal. Asking the complainant to put matters in writing also risks escalating matters.

Sometimes, when complaints or feedback are raised over the phone, it may be helpful to arrange an in-person meeting or a video call, ensuring confidentiality and keeping written records of these discussions. In person meetings offer nuance and subtlety which can be lost in written communications or on the phone; however, it is important to consider the patient’s preferred way of communicating. GDC clinical advisers routinely encounter letters that say the same thing: “No one would listen.” The importance of timeliness, sympathy and actively listening cannot be emphasised enough. If this is unsuccessful the patient should then be encouraged to resolve this locally with the use of organisations such as the Dental Complaints Service or the local ICB who will look to deescalate the matter and attempt to resolve the complaint to the satisfaction of both parties. More information can be found here: What we can help with.

The GDC should be the last resort for patients or their guardians to raise a complaint about their treatment or service. Given the several hundred clinical concerns the GDC (FtP) receives each year against the backdrop of the vast number of treatments carried out daily across the UK and the size of the GDC register, it is highly likely that most issues are resolved locally. This highlights the importance of robust and effective local complaint handling.

The GDC's own data shows that in the 650+ cases they have treated as initial inquiries to date, 21% of all the concerns raised by patients relate to communication issues. Communicating clearly and effectively is one way to ensure that patients are fully informed and involved in their treatment and could potentially make the difference in preventing a complaint being made.

Sorry seems to be the hardest word

Many dental professionals find apologising difficult, yet an effective apology (especially when made face-to-face) can diffuse tension, show empathy, and prevent escalation. In fact, in my experience, the absence of an apology is often what patients cite as the heart of the complaint.

I recall a case where a dentist accidentally spilled a small amount of a caustic agent on a patient’s face. Instead of acknowledging the incident or expressing regret, when a concern was raised, the dentist replied, “That’s fine. How do you know it was me. Let’s see what my insurance company says.” The patient was not seeking compensation - only a sincere, human apology. Sometimes the most powerful word we can use is the five letter one: sorry.

The GDC’s Standards for the Dental Team and the Duty of Candour make it clear that patients must be able to raise concerns easily, and that dental professionals should respond openly and honestly with clear and full explanations, apologise, and if possible, offer solutions or support to remedy the matter. This can help to build trust (the other powerful five letter word).

An apology does not imply wrongdoing; however, it acknowledges the patient’s experience and demonstrates a willingness to help. As I have said in a previous blog, clinical advisers recognise that things don’t always go to plan. But showing evidence that the patient’s interests were put first can have a positive impact on the adviser’s view of the case and on how the matter progresses overall. It is a requirement to ensure that there is an effective complaints procedure that is readily available for patients to use and to follow the procedure, to include the stages involved and the timescales. All team members should have a working awareness of the complaints procedures and training with complaints handling.

Example B: A patient returned the day after receiving a porcelain‑fused‑to‑metal crown at a lower second molar tooth, reporting that it “felt high.” Instead of opening a discussion, the dentist dismissed the concern without clinical assessment and advised the patient to “give it time.” The patient then submitted a written complaint. The dentist responded with a succinct, technical letter stating: “I checked the occlusion with articulating paper, and it was fine. I can drill down the opposing tooth or adjust the crown, but I will not take responsibility for any damage. A refund will not be provided. It is best you consider seeking care elsewhere.” The patient felt dismissed, confused by jargon, and alarmed by the mention of drilling a healthy tooth. They had not sought a refund - only reassurance and some answers. This case highlights how defensive and deficient responses can escalate concerns rather than resolve them. There is the need to offer a constructive response to the complaint, to listen to patients who complain, and to find out what outcomes they want from the concerns they have raised.

A clear, accurate, detailed and professionally structured reply ideally with guidance from an indemnity provider can help to de-escalate matters and assist any third party – especially when they are reviewing clinical records which might be lacking in the necessary clarity, detail or depth. This is often understated, as GDC clinical adviser investigations are limited to records and correspondence only (without any clinical assessment or direct interaction with either the complainant or the dental professional). A detailed and well-crafted letter can offer vital clarification. It is essential to address every point raised in the complaint, avoid unnecessary delays, use unambiguous language, and offer practical solutions.

Removing a patient from the practice without good justification often inflames matters, and in my experience, this is often the trigger point for a GDC referral. Keeping them engaged, where appropriate, can help to preserve options such as referral or continuity of care. That said, clinicians should not deliver treatment they are not confident, trained, competent, or indemnified to provide, or when the professional relationship has broken down. Any decision to end care must be communicated effectively and be justifiable.

Example C: A patient with an infected upper premolar tooth that had been restored using a metal crown was advised to undergo root canal treatment, but the dentist instead only replaced the crown with an aesthetic variety and then discharged them. The patient later developed an acute abscess and sought treatment elsewhere. Their subsequent written complaint requested clarification of the clinical rationale, as the infection at the tooth had not been addressed. The dentist replied that the crown had been replaced because it was “contaminated”, but the response arrived three months after the complaint was received, with no explanation for the delay, and further relevant queries were side-stepped.

Examples A to C reflect how unclear explanations and delayed communication often fuel dissatisfaction more than the clinical care itself. There is the need to acknowledge the complaint – ideally within 2 working days and to respond to the complaint in the time limit stipulated by the complaints procedure. However, if delays are incurred, regular updates at least every 10 days should be provided. In case C, the response was misleading. This can sometimes attract far greater criticism from a GDC clinical adviser than clinical deficiencies. Patients expect honesty and transparency. The complaint response should set out the findings and any practical solutions that may be on offer.

Example D, in contrast, offers an illustration of the value of a thoughtful response. A patient complained about prolonged discomfort after a complex extraction. Although the procedure had been documented well, no post-operative follow-up had been arranged, leaving the patient feeling abandoned. In response, the dentist provided a detailed and empathetic letter, acknowledged the patient’s experience, clarified the clinical events, and offered a review with another clinician. The patient commented that this was the first time they felt “taken seriously.” Nevertheless, they still reported concerns to the GDC about the dentist’s technical skills. The response may have helped support earlier closure of the case. The fitness to practise process centres on establishing if a registrant’s fitness to practise is currently impaired. Being able to show that you have proactively reflected on what has happened (and taken steps to deal with the aspects of your practise) will show that you have positively dealt with the concerns.

Occasionally, complainant accounts conflict with the dental professionals’ clinical records; or the clinical records do not offer further insight – often seen with conduct related matters such as allegations of rudeness or shouting at patients. The GDC may sometimes request information from other team members, and brief contemporaneous notes of significant incidents by them can be invaluable, especially when complaints arise long after the event has taken place.

It is also important to remember that copies of complaint correspondence should be stored separately from the main clinical notes so that patients are not discouraged from making a complaint, but these items must be supplied when requested.

Final reflections

Complaints can be unsettling, but they also provide an opportunity to listen, reflect on your practise and improve to provide better treatment. Approaching complaints with empathy rather than defensiveness can strengthen the patient-professional relationship and support a healthier professional culture. A robust local complaints process can also help concerns to be resolved quickly and compassionately, minimising escalation.

Effective learning from complaints by the overall team can help practices improve communication strategies, consent processes, record keeping, expectation setting and reduce the likelihood of similar issues recurring.

The quest for technical excellence remains a facet of clinical dentistry. However, excellence is not technical perfection; it is the combination of skill, compassion, communication and a willingness to learn from every experience - including complaints and professionalism.

Where can professionals go if they need more help or want to know more?

When you receive a complaint, it is sensible to consider contacting your indemnifier as soon as possible for advice to help avert escalation. Together with other stakeholders, six core principles for best practice with good complaint handling have also been developed – please look at them - Complaint handling best practice.

The following sources of information may also be helpful:

• Standards for the dental team
• DCS: Complaint handling best practice
• Duty of Candour
• NHS Complaint Standards | Parliamentary and Health Service Ombudsman (PHSO)
• Dental Complaints Service What we can help with
  

This blog is part of a series by Shamir Mehta, please read his other blogs:  

Dental record keeping: what is professional, reasonable and in the interest of patients? 

Clear aligner treatment: What can we learn from complaints and concerns? 

How patient consent can help build trust and confidence

Drills, spills, and protocol: when dentistry doesn’t quite go to plan

‘Bonding boom’ - composite bonding insights for dental professionals