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January 2008 Patients | MALPRACTICE Avoid the blame game Practical advice for protecting yourself from malpractice claims. modernhygienist.com | January 2008 The patient with a severe case of periodontal disease that could have—should have—been caught sooner. The oral cancer lesions inside your patient’s mouth that went unnoticed. The procedure that somehow went wrong, resulting in a patient injury. As a hygienist, these are all outcomes you never want to encounter. Not only do they hurt your patients, they could lead to malpractice claims. Undiagnosed periodontal disease and oral cancer are the basis for many of the most costly malpractice claims in dentistry, and both are under the scope of dental hygiene, speaker and author Patti DiGangi, RDH, BS, says.
But there are other reasons unhappy patients may decide they want to take you to court—ranging from not reporting an error to a miscommunication regarding treatment options. Sometimes patients file claims because they feel wronged and want someone to pay. Other times, the claim is unjustified and just about money. While malpractice claims against hygienists aren’t common and are usually settled out of court, they can be devastating emotionally, professionally and financially when they do surface. That’s why it’s important to know what you can do to protect yourself and to do it now; once a claim is filed, it’s too late. write it down Keeping accurate, complete patient records during the entire course of treatment is key to defending yourself against malpractice claims. Medical histories should be kept up-to-date while any findings, treatment recommendations and treatment refusals should be documented. “Most hygienists say zero time of the appointment is committed to documentation,” DiGangi says. “That’s part of the reason we have the poor recordkeeping that we do. It has been legally interpreted time after time that if you didn’t write it, you didn’t do it.” When it comes to documentation, think back to the basics you learned in school, Linda Harvey, RDH, MS, LHRM (license healthcare risk manager) of Horizon Consulting Group says. And while it’s important to be thorough, don’t reveal unnecessary information that may be damaging if a claim is ever filed. If you break the tip of a curette while working on a patient, don’t write in the record that you or another hygienist may have sharpened it too thin. It can be just as damaging if you report too much as opposed to too little information. Recordkeeping guidelines vary by state, Harvey says, so it’s important that you know the standards where you practice.
Keep talking It may seem like common sense, but communicating with your patients is key when it comes to avoiding malpractice claims, Rebecca Wilder, RDH, BS, MS says. Make sure they understand their diagnosis and their treatment options. Educate them about what you do. Most importantly, be honest with your patients, says San Francisco-based attorney and periodontist Edwin Zinman. Report your findings to them and if you make a mistake or miss something, admit it. Most patients are forgiving if you own up to your mistakes, and are less likely to take legal action if they hear it from you rather than someone at another practice. “Tell the truth, the whole truth, and nothing but. Tell the patient the findings, and the patient then has the right to refuse treatment,” Zinman says. “Don’t x-ray pockets and decide the patient can’t afford to see a periodontist so you’ll just watch it.” Communicating with your patients goes beyond just words. Body language also is an important element, says Wilder, who is Associate Professor and Director of Graduate Dental Hygiene Education at the University of North Carolina-Chapel Hill. Really listen to your patients. Make eye contact, nod when appropriate and stay at eye level when speaking to them about their condition or treatment options. Make them feel comfortable. “Typically, happy patients don’t sue. When a patient decides to sue, it’s most likely because they feel they have been wronged,” Wilder says. insure yourself Yes, the dentist you work for likely has liability insurance. It may even offer you some coverage, but it isn’t enough. Dental hygienists should have their own insurance, DiGangi says. Those who don’t may get burned. When patients file malpractice claims, they usually go after the “deep pockets,” most often the dentist, says Shirley Gutkowski, RDH, BSDH. Hygienists typically aren’t listed on malpractice claims solo, but more often they’re named along with the dentist. If that happens, chances are the practice does not have enough liability insurance to cover you, the dentist and other staff members named in the suit. “Most hygienists are patted on the head and the doctor says, ‘don’t worry, we have you under our umbrella,’” Gutkowski says. “But the policy can run out of money. The modern hygienist has her own liability insurance.” Relying on the dentist’s insurance also can be an issue if there is a conflict, Zinman says. Maybe the dentist decides to point the finger at you or even fires you from the practice. In these scenarios, that practice’s insurance doesn’t do you any good, and puts your personal assets at risk.
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