How Do You Deal with Undesirable Results?
Perfect outcomes are not always possible in every procedure. Even though we strive for the best results, our patients sometimes must accept undesirable results.
How do we handle these situations?
Establish a Relationship
Foremost in any treatment that we render is the need to have invested time and attention from the beginning of the patient/doctor relationship in order to develop a comfortable rapport. Gaining a patient’s trust starts by showing our investment in their well-being.
Establish Expectations for Our Patients
If we as practitioners know in advance that a procedure is risky or that an ideal result will be challenging to achieve, we need to be upfront with our patients. Honesty is the best policy.
As oral surgeons, expectations for our more involved procedures are best set at an initial consultation appointment. Any surgical procedure, especially an elective one, is a complicated decision for patients. In order to provide true informed consent, our patients need to understand the most likely risks and benefits of the procedures that they’re planning to pursue. Additionally, there needs to be a complete understanding of the treatment course, including the recovery period and eventual follow-up suggested for maintenance of the desired outcome.
The best way for our patients to provide informed consent is to have a chance to mentally digest the decisions they are making, having time to ask questions, contemplate their choices, and ultimately own a realistic expectation for the possible outcomes. For more involved procedures, this is best achieved by having an initial consultation appointment on a different day, prior to the day of the procedure.
Establish Expectations for Ourselves
Sometimes, we take on cases that, in hindsight, we analyze and realize there was a limited likelihood of a desirable outcome. We constantly need to remind ourselves of our limitations and to not get caught up in the “God complex” that is sometimes assigned to us by patients.
As doctors, an ounce of humility goes a long way. And if our patients see us as people from the beginning, they will more likely accept having an undesirable outcome.
Take Stock, Take Responsibility
Intra-operatively, if we as dentists find that a procedure is not going as planned, we must constantly assess and reassess the treatment we are providing. What are the consequences of aborting a procedure vs. trying to complete a procedure that may ultimately incur undesirable complications?
Regardless of which decisions we make, we must take the time to explain to our patients the surgical decisions we made and the outcome of those decisions. We need to build on the rapport that we fostered at the initial consult, reinforcing for our patients that we had and continue to have their best interests in mind and will guide them through their recovery.
Patients who must face undesirable complications from our procedures are vulnerable. We took patients who were “well,” and we made them “sick.” They need us as expert counsel to help them manage their challenging outcome in the best way possible…to minimize exacerbating their complications and to continually remind them that they are not alone.
It’s About Commitment
Patient abandonment is a form of malpractice that occurs when a doctor terminates the patient/doctor relationship without reasonable notice or cause, failing to provide the patient with an opportunity to find a qualified replacement care provider. As an oral surgeon who takes call at a local hospital, I’m discouraged when one of my colleagues or I am contacted by the emergency room to manage patients who were abandoned by their treating dentists.
Why are patients abandoned by treating dentists? In the cases I have come across, the dentists were not qualified to perform the procedure and/or they failed to take ownership over their patients when managing their outcomes.
We as doctors are obligated to be available to our patients after-hours and on weekends for any problems that arise from the treatment we’ve provided. Additionally, we should ideally have a Rolodex of other providers whom we can contact personally in times of need. If we find ourselves “in over our heads,” we can then shepherd our patients to the providers who we know can provide the needed care.
If our plan for managing patients with undesirable outcomes is to merely send them to the emergency room and not even be available to the on-call providers who take over care of the problems we’ve created, this is woefully inadequate. Our patients deserve better and we as doctors must strive not to violate the very principles of the Hippocratic Oath we are sworn to uphold.