Dispute Resolution

A Peer Review Process

The Dentist-Patient Relationship

Mutual Trust. It is the heart of every successful relationship. From friendship and family life to business.
Trust is an important part of oral health care too. The foundation of a good dentist-patient relationship, one that encourages and promotes good dental health is good communication. A sincere effort on the part of the dentist and the patient to discuss the course and cost of treatment and the expectations of the outcome can go a long way toward establishing mutual trust.
An unasked question or unexpressed concern can undermine trust. A simple conversation almost always resolves doubts and answers questions.
In those instances where a problem or misunderstanding cannot be resolved, the recourse available is the peer review process.

About Peer Review*

Peer review is a process by which the dental profession reviews and resolves problems or misunderstandings regarding dental treatment. Peer review exists for the benefit of the patient, the dentist, and the third party.
Every dental society has established a peer review process to resolve disagreement about dental treatment that a patient and a dentist have not been able to resolve themselves.
A peer review committee consists of dentists who volunteer their time and expertise to consider questions about the appropriateness or quality of care, or about the fees charged in a given set of circumstances. The members of the committee will be impartial and their services are available to those who participate in the process.
A dispute may be resolved through mediation alone, or thorough review of patient records and clinical examination.
The dentist and the patient will be informed of the committee''s decision and recommendation for resolving the problem.
Most importantly, the committee makes its recommendation in the hope that it will provide for a reasonable and mutually agreeable solution for the parties involved.

The Review Process

  • A written request for review - but not specific relief - is submitted to the state or local dental society. The request should include all necessary and appropriate documentation that would help to clarify or support the circumstances.
  • The request is reviewed for completeness and referred to the appropriate peer review committee.
  • The chairman of the peer review committee reviews the request and appoints one member of the committee to attempt to mediate the problem.
  • The mediator contacts all parties and attempts to reconcile the problem. A clinical examination is not conducted during the process of mediation.
  • If the problem is successfully mediated, a written report is submitted to the committee chairman and the case is closed.
  • If mediation is not successful and further action is necessary, the chairman is advised and a committee of at least three members is appointed. - The committee may meet or discuss the case and may examine clinical records, talk to the patient and the dentist and if necessary, arrange for a clinical examination.
  • The committee concludes its review and all parties are notified of the decision and recommendations in writing.
  • If any of the parties are not satisfied with the decision and can show just cause for an appeal, the case can be appealed to the appropriate peer review appellate body.
  • The decision of the appellate body is final within the peer review context.
  • All information regarding a particular case is kept strictly confidential.

Although the peer review system can satisfactorily resolve the majority of complaints received, there are limitations that may disqualify a complaint from being reviewed.  The following are complaints that are not handled within the system:

Cases which do not meet the "time" criteria: a complaint will not be reviewed if treatment was completed three (3) or more years prior to complaint, or more than one (1) year from the date the patient became aware of the problem.

Cases in litigation: the peer review system is an alternative to civil litigation, therefore a complaint will not be reviewed if either party has initiated litigation before or during the peer review process.

Cases petitioning for monetary awards: requests for reimbursement of lost time from work, pain and suffering, mileage, etc. will not be reviewed by the peer review system.  The system is not a punitive system, but rather an evaluative one.

Cases not related to treatment: attitude and communication problems of a dentist or dental staff will not be reviewed by the peer review system.  These complaints are outside the purview of peer review.

In Summary

Peer review provides an impartial, easily accessible and generally expedient means for resolving misunderstandings regarding dental treatment. It exists for the benefit of the patient, the dentist, and the third party.
Peer review is not a court of law. It is generally a voluntary process that relies on the good faith between a dentis, a patient, and their mutual interest in good dental health.

Disclaimer

*This information is general in nature. Participants in peer review must consult with their own legal counsel to assure that their peer review program complies with applicable law, bylaw provisions, and insurance protection.

For more information and Mediation Form for completion, click here to download form.
Questions? Contact the San Antonio District Dental Society, (210) 732-1264.

American Dental Association
Council on Dental Benefit Programs
211 East Chicago Avenue
Chicago, Illinois 60611-2678

Texas Dental Association
1946 IH-35 South, Suite 400
Austin, Texas 78704-3698

San Antonio District Dental Society
3355 Cherry Ridge, Suite 214
San Antonio, Texas 78230-4818