Don't begin treatment before making sure your patient knows what you are going to do.

While this may seem obvious, many claims can be avoided by the simple step of confirming with the patient what you intend to do that visit. I was involved in a claim by a patient who was told by the front office staff that the doctor would smooth out her incisor to hide a small chip. After seating the patient, the doctor immediately started what he thought was the planned procedure -- a full crown! Always confirm directly with the patient what they think is going to happen that visit.


Don't bill for work until it has been completed

Most insurers pay for work when complete. Don't bill that crown until permanent cementation or you risk not only problems with the insurer, but also the patient if they go elsewhere for permanently cementing the crown only to discover their insurance won't pay the new dentist because they already paid you.


Don't scare your patients into agreeing to have multiple crowns done.

Avoid using purchased intra-oral slides showing horrible, decayed and broken down teeth for the purpose of convincing your patient to have crowns made. One dentist's insurer paid six figures to settle a claim by a patient who claimed she was scared into agreeing to have multiple crowns to avoid her teeth falling out just like shown in the slides.


Be careful about suing your patient for unpaid bills.

In my experience, patients refuse to pay their bills for one of two reasons. Either they cannot afford it, or they are unhappy about some aspect of their treatment. If they are unhappy about their result, the minute you commence aggressive collection, they will commence finding an attorney to represent them in suing you for malpractice. My experience is that patients equate bad result with malpractice and sadly, many lawyers don't understand the concept of the standard of care and see only the bad result and assume it is a good case. Avoid that by writing off the debt or negotiating a deal with the patient (be sure to get a release signed).


Don't hide the fact you broke an instrument in the canal - a surprised patient is often an angry patient.

While breaking off the file tip in the canal may not violate the standard of care, prudence requires that the patient be told about it so that the patient can be on the alert for any signs of problems. You don't want the patient's first knowledge of it to come from the new dentist down the street. Be sure to document in your chart that the patient was notified.


Do not allow your patient's insurance coverage to dictate treatment

I represented a dentist who held off scheduling his patient for badly-needed crowns because the patient's dental insurance had been used up for the year. The patient sued when she went to a new dentist several months later and learned that the long delay caused her additional injury -- the chart said nothing about the reason for the delay in scheduling. This is an easy trap to fall into, even though you are doing it for the patients financial benefit. Open discussions with the patient and clear charting of the discussion will avoid misunderstandings and claim.


When you make a mistake in the chart, do not erase it.

Do not erase or obliterate entries in the treatment records. When a mistake occurs, rather than erase or obliterate the incorrect entry simply draw a single line through the entry, mark it "error" or "incorrect entry" and date it to show that it was discovered and changed on that date. While an erasure may seem innocuous at the time, if the patient later files suit, it looks very bad to have an erased entry. There are dozens of "questioned documents" experts ready and willing to pour over your original chart looking for changes. A simple case can turn into a nightmare very easily.


Avoid altering the patient treatment record - especially after receiving notice of a claim.

Resist the temptation to add information in the chart after-the-fact (meaning after learning of a claim). If you failed to properly notate the chart, that can be dealt with by your defense counsel (who will argue that it is a rare case where the failure to notate something in the treatment chart caused injury to the patient). Alterations give the appearance of hiding something.


Refer those patients who need treatment beyond your comfort zone

You know what your comfort level is. If you decide to treat a patient for a procedure that most reasonably competent general dentists would have referred, you will be held to the same standard of care as the specialist. I have had many failed endo cases and many extraction cases where the result was less than optimal and the patient sued, claiming that the endodontist or oral surgeon would have achieved a better result. This is particularly true when economic times are tough and many general dentists have a hard time referring patients to specialists.


Do not ignore the inquiry letter from the Dental Board

If you receive an inquiry letter from the Dental Board, do not ignore it. The Dental Board is required to investigate patient complaints. Many of these complaints are unwarranted and totally without merit. Nevertheless, do not assume that the Dental Board will figure that out without your having to waste your time responding to their inquiry. They expect you to cooperate in their investigation, and it is a mistake to fail to respond. They cannot properly investigate without your cooperation (you will need to provide copies of the treatment records and x-rays). Help them see why the patient's complaints are meritless. I recommend that you enlist the assistance of your attorney in responding to these inquiry letters. Your attorney can assist you in properly responding to the inquiry, and can work with you to word an effective rebuttal to the patient's claims.