Understanding Malpractice Risk: Advice for New Dentists

Transitioning from dental school to professional practice can be an exciting but overwhelming time for new dentists. Many new dentists tell us that anxiety over potential malpractice claims weighs on their minds, and they are unsure of the role insurance plays in safeguarding their careers and financial futures. The definition of what constitutes dental malpractice in Canada is regulated provincially, but in general it occurs when there is a failure to provide a standard level of care to a patient, leading to harm or injury1.

To shed light on the role played by risk management strategies and malpractice insurance, we spoke with Julie Berthiaume, Senior Advisor at CDSPI Advisory Services Inc. Julie’s wealth of knowledge and extensive experience advising new dentists makes her the ideal guide to explore the world of malpractice risk and insurance.

When a "minor" incident becomes a "major" problem

“Most new dentists have a good sense of what types of patient interactions could lead to a malpractice action,” Julie believes, “but they are often surprised when I tell them about some of the real-life situations we’ve seen. The very serious ones where a patient dies or is seriously injured make the news, but even what seemed like a minor incident at the time can lead to a major problem.”

Here a just a few common examples she uses of routine practices and procedures that can lead to a malpractice action:

  • A faulty restoration that requires corrective procedures.
  • A defective or ill-fitting dental device that causes pain or discomfort.
  • Wisdom tooth extraction or root canal procedure complications.
  • Lip, tongue, and jaw injuries as the result of a procedure.
  • Extracting the wrong tooth.
  • An injury resulting from an anesthesia error.

 

 “I like to remind new dentists that as licensed practitioners, they are legally responsible for the services they and their staff provide,” Julie explains. “It is crucial that they recognize that even seemingly minor incidents can lead to malpractice actions. That means staying vigilant and practicing good risk management habits.”

Stay alert to the potential "warning sights" of a potential malpractice accusation

Part of being vigilant is knowing and recognizing the warning signs that a malpractice action could be on the horizon and getting ahead of potential risks. Some common indicators that Julie suggests dentists and staff can watch out for include:

  • Persistent or escalating patient complaints, dissatisfaction, or negative online reviews about the quality of care, treatment outcomes, or communication can indicate underlying issues. Addressing patient concerns promptly and professionally can help prevent dissatisfaction from escalating into legal action.
  • Patients who report inadequate communication regarding treatment plans, risks, benefits, and alternatives can lead to misunderstandings and disputes. Patients should be fully informed and have the opportunity to ask questions and provide informed consent.
  • Patients who have unrealistic expectations about treatment outcomes or who feel their expectations were not met may become dissatisfied. Setting clear and realistic expectations through effective communication is key.
  • On-going, unresolved patient disputes or concerns can escalate. Addressing issues promptly and professionally can often prevent further complications.
  • Repeated incidents of similar patient complaints or issues can indicate systemic problems within a practice. Identifying and addressing the root causes can help prevent future malpractice claims.
  • Patients who report inadequate follow-up care or progress monitoring after procedures. This could lead to post-treatment complications.

Julie stresses the importance of being proactive about patient communication and ensuring that staff are trained to recognize these warning signs. Both clinical and administrative staff should be empowered to maintain open lines of communication with patients and to use the tools in place to record and share patient feedback and concerns.

Understanding the role of accurate documentation

Something that Julie believes cannot be emphasized enough is the role that accurate and thorough documentation plays in mitigating malpractice risks. “New dentists may not be thinking of the importance of clear and legible patient charts now, but those charts will be key evidence in defending malpractice claims later,” she said. "Dental (or patient) charts provide concrete proof and support their position in case of a lawsuit. It’s so important, and dentists need to be proactive about it – with themselves and their staff," she explained. “If their charts or other notes are not clearly legible, their value as evidence may be compromised. Also, some dentists develop their own abbreviations, acronyms or other jargon that may not be generally understood. This should be avoided. Even with computerized charting and records, they need to make sure entries are complete and comprehensible.”

Julie makes a point of cautioning new dentists against altering or deleting information in a chart, since it could raise questions and undermine their credibility. In fact, notes should not even be reopened after an incident is reported since that activity can be found by forensic audit later. Even if there is no intent to alter the record, the metadata could later be interpreted as an attempt to cover something up.  In particular, she emphasizes the importance of documenting everything in detail and seeking guidance from a trusted partner like CDSPI when an incident happens. "I tell them to contact us immediately if they suspect an issue is brewing, and we will guide them through the process. There's no downside to this. Their rates are not going increase because they talked to us about a potential claim.”

She reminds them that CDSPI provides support and expertise to dentists in navigating malpractice challenges.

The role of malpractice insurance

Knowing what type of incident can result in an action, watching for warning signs such as an accusation, and keeping accurate records are effective ways to manage malpractice risk; but legal action can still happen. When advising new dentists, Julie believes it is important to be realistic. "No matter how careful we are, accidents can happen,” she explains. “I advise new dentists that malpractice insurance is there to help defend them and their corporation." That’s because accusations of malpractice, even if unfounded, can have significant financial consequences and may lead to reputational damage for dentists.

Julie stresses the need for dentists who face these kinds of accusations to be ready to defend themselves. “Legal fees can accumulate rapidly and become a heavy burden on their financial well-being,” she explains. “Having adequate malpractice insurance coverage helps to ease that burden.”

Selecting the appropriate amount of malpractice coverage is a key decision for dentists. While the minimum coverage offered by CDSPI Malpractice Insurance is $3,000,000, Julie’s message for new dentists is that there is no one-size-fits-all answer. Every dentist needs to consider factors such as their specialization, whether they will be performing surgeries, and if they will use IV sedation. She encourages dentists to envision worst-case scenarios and assess their personal comfort zone when selecting coverage amounts.

"I tell them to consider the potential risks they may face in their practice and weigh them against the financial impact of higher coverage limits," she told us. “It’s not the easiest conversation to have, but it is key to getting them thinking about the risks.” Importantly, she reassures them that their coverage can be adjusted throughout their careers according to need. “The additional cost of going to a limit of $5 million per claim from $3 million per claim is about $110 per year,” she points out, “and that is based on a $1,000 deductible”.

A malpractice action affects more than the bottom line

While the financial implications of a malpractice case are significant, the mental health impacts on a dentist should not be overlooked. Often the experience is emotionally challenging and can be psychologically devastating. The process of dealing with a malpractice case, including legal proceedings, investigations, and uncertainties, can lead to heightened levels of stress and anxiety. Dentists may also experience feelings of guilt and shame, especially if they believe they made a mistake that caused harm to a patient. These emotions can be overwhelming and lead to self-blame and negative self-perception. This kind of prolonged stress and uncertainty can contribute to feelings of depression, persistent sadness, lack of interest in activities, and a sense of hopelessness about their situation. Dentists facing a malpractice case might feel isolated and alienated from their colleagues, friends, and even family members.

A malpractice action can also shake a dentist's confidence in their clinical skills and decision-making abilities. They may second-guess themselves and become hesitant in their practice, leading to a decline in self-assurance. Dentists may develop a negative self-image because of the case, perceiving themselves as failures or inadequate professionals. This distorted self-perception can further contribute to mental health challenges. For some, the experience of a malpractice accusation can be traumatic. The threat to their career and reputation, combined with the legal and emotional challenges, can lead to symptoms of trauma, including flashbacks, nightmares, and hypervigilance.2

It's important for dentists facing a malpractice case to prioritize their mental health and seek support. Connecting with mental health professionals, such as therapists or counselors, can provide a safe space to process emotions and develop coping strategies. Help is available from the Members’ Assistance Program (MAP) – sponsored by CDSPI at no cost to members of participating dental associations – providing confidential counseling services, wellness resources, and work-life support to dental professionals.  Additionally, while not divulging the substance of a case, seeking guidance from peers, mentors, and professional organizations can help dentists navigate the psychological toll of a malpractice action and work toward healing and recovery.

Getting your malpractice insurance

There is no question that new dentists have a lot going on in their lives. “Doing the research” on malpractice insurance coverage and requirements isn’t always a top priority. When advising new dentists, Julie begins the discussion by outlining the options available to them in Canada. “In Alberta and Ontario,” she explains, “coverage is provided through the provincial regulatory body. for a standard limit of $2,000,000. However, dentists in these provinces can opt for more protection through CDSPI with Excess Malpractice Insurance.”

For dentists practicing outside of Alberta and Ontario, CDSPI is the primary provider of Malpractice Insurance. “I always stress to students that they have to apply for both malpractice insurance and their license at the same time,” Julie told us. “This can be tricky and CDSPI will help them coordinate things.” She recommends that new dentists consider their plans and timelines carefully, since getting a license triggers the mandatory requirement for malpractice insurance, regardless of whether they have begun practicing or not. “It is really a great time to reach out to CDSPI.”

Face the future with confidence

The transition from dental school to professional practice is filled with excitement, challenges, and the responsibility of safeguarding one's career. It is important for new dentists to start acquiring the tools and advice they need to protect themselves, their patients, and their financial futures. Through the guidance of experts like Julie Berthiaume and the resources offered by organizations like CDSPI, new dentists can better equip themselves to embrace the opportunities and overcome the challenges that lie ahead.

By selecting appropriate malpractice insurance coverage and prioritizing accurate documentation, dental professionals can confidently embark on a successful and fulfilling career in dentistry.

1 For a comprehensive definition of dental malpractice, please refer to your provincial association or professional college.

2 Nancy A. Ryll, Living Through Litigation: Malpractice Stress Syndrome, Journal of Radiology Nursing, Volume 34, Issue 1, 2015, Pages 35-38.

CDSPI Malpractice and Excess Malpractice Insurance are underwritten by Zurich Insurance Company Ltd (Canadian Branch) and provide coverage subject to the Policy Terms and Conditions governing each plan. Excess Malpractice Insurance is offered to dentists licensed to practice in the province of Alberta or Ontario, who are a member of their provincial dental association and have their primary mandatory malpractice insurance directly from their provincial regulatory body. This is intended as a general description of certain types of coverage available to qualified customers through Zurich Insurance Company Ltd (Canadian Branch). Nothing herein should be construed as a solicitation, offer, advice, recommendation, or any other service with regard to any type of insurance product underwritten by Zurich Insurance Company Ltd (Canadian Branch). Your Policy Terms and Conditions is the contract that specifically and fully describes your coverage. The description of the policy provisions contained herein gives a broad overview of coverage for informational purposes only and does not revise or amend the Policy Terms and Conditions.

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