By Dr Elaine Cook and Dr Noel Kavanagh, Dentolegal Consultants at Dental Protection
Managing expectations is one of the more challenging aspects of dentistry. The more realistic a patient’s expectations, and the more aligned they are with the eventual outcome, the less likely they will be unhappy with treatment, and make a complaint. Identifying and addressing patient expectations is therefore important in managing your risk. This is especially true when patients are considering
elective treatment for cosmetic reasons, compared with clinically necessary interventions to treat disease or maintain dental function.
Causes of unrealistic expectations
- Lack of information: Opening hours/access to dental care, wait times, treatment availability or complications of treatment.
- Too much information: Patients might attend the practice with a preconception of how they want to be treated, basing their expectations on internet searches, past dental care experiences or those of friends and family whose situation may have been different.
- Not checking understanding: It is important to allow enough time to check a patient fully understand the issues involved in their care, the potential complications of their treatment or alternative treatment options.
- Time pressures: Allocating insufficient appointment time undermines the ability to establish a good rapport and a professional relationship with patients which is important to gaining patients’ trust.
- Anxiety: If a patient is anxious this can compound their ability to absorb/process information and make misunderstandings more likely.
Managing patient expectations
1. Make information about the practice easy to access
Clear and consistent information from all members of the team, on the website, social media, answer phone and posters in the waiting room can help patients know what to expect. Let them know how long appointments should last, the procedure when arriving at the practice, opening times, treatment fees etc. Principle two of the GDC’s Standards for the dental team directs you must treat patients as individuals1. You should take their specific communication needs and preferences into account where possible and respect any cultural values and differences. This includes making reasonable adjustments for patients for whom there are barriers to communication.
It is a registrant’s professional responsibility to ensure any advertising, promotional material and website is accurate and not misleading about their skills and qualifications.
2. Ensure you communicate in ways the patient can understand
Patients want clear explanations about their dental condition, treatment options, and post-treatment care. Avoid using dental jargon, technical terms, or abbreviations to prevent confusion. Remember that each patient is different and will have different needs and levels of understanding. Use visual aids, models, or digital images. Providing patient information leaflets to read at home may be a helpful addition to the information provided in surgery. In accordance with the Equality Act 20102 consider large print, braille, audio, or electronic formats.
Development in digital technology has helped to provide new tools to support communication both in-surgery and remotely, for example, the ability to annotate images / videos, interactive educational tools and the ability for patients to re-access information and provide confirmation of understanding.
3. Encourage two-way communication
Have an open and honest conversation with the patient. Patients have a fundamental need to be heard and understood but this will also give the treating dental clinician a clearer understanding of the patient’s expectations. Encourage active listening by the whole dental team. Establishing a good rapport and professional relationship with the patient goes a long way to gaining their trust – and consequently, improving their experience of their care.
4. Check understanding
Anxiety, physical disabilities, cognitive impairment and other circumstances can make it harder for patients to absorb the information you give them during appointments. Do not make assumptions about what the patient will or will not understand. Patients will have varying degrees of knowledge and experience regarding dental treatment. Check that the patient has truly understood all the information provided.
5. Set realistic timeframes
Effective time management skills increase your focus and productivity. Educate patients about the limitations of time during appointments and emphasise the importance of prioritising their concerns. Setting realistic timeframes helps manage patient expectations and ensures that each concern receives proper attention. Providing patients with sufficient time positively changes their perception of the level of care provided.
6. Address unrealistic expectations
When a patient requests a very particular form of treatment, be especially mindful of the patient’s expected outcome. If an unrealistic expectation is expressed, respectfully correct it. Pay particular attention to the patient who resists having their unrealistic expectation corrected. Increasing expectations may equate to increased risk.
7. Manage your own expectations
You need to be clear about what can be delivered. It is extremely important to only work within your level of confidence and competence. When bad news is not effectively communicated, the dental professional may unwittingly create false hope for the patient3. Clinicians will sometimes find themselves attempting to manage failing dentitions with “herodontics”. In most of these cases, it is only a matter of time before failure inevitably results. When it does, not only can the situation be harder to manage, but the false hope and increased expectations created can lead to negative consequences for an increasingly disappointed patient. This in turn can have dentolegal or regulatory repercussions for the dental professional who may well feel genuinely aggrieved, believing that they have gone above and beyond the call of duty for the patient4.
8. Avoid misrepresentation
It is important that we do not mis-represent our own abilities or skills. Care should be taken to ensure any communication with patients, or in the public domain, does not imply specialist skills or qualification unless the dentist is registered as a specialist in that field.
References
1GDC Standards for the dental team. General Dental Council – Communicate effectively with patients
2Equality Act 2010. Equality Act 2010
3Waylen A. The importance of communication in dentistry. Dent Update. 2017; 44:744-780
4Andrew James Paterson. Avoiding disasters in restorative dentistry by effective communication. Dental Update 2024 48:3, 707-709.
