The business of being a dentist
How peer review committees help everyone involved

You can fool too many of the people too much of the time.
– James Thurber, 1894-1961

Dr. Steve Gustafson is trying to make sure that doesn’t happen as often as it once might have.

Most people don’t know Michigan has a peer review system to mediate disputes between dentists and patients. It’s called the Michigan Dental Association (MDA) Committee on Peer Review.

“This is a positive committee designed to help organized dentistry and patients,” Dr. Gustafson says. “The goal isn’t to be punitive. The goal is to resolve conflicts between dentists and patients before they get to the lawsuit stage.”

This is Dr. Gustafson’s sixth year as a peer review committee member for Oakland County. The MDA divides Michigan into different districts; each district has its own peer review committee.

“That division keeps the time very short for a complaint to be heard,” according to Dr. Gustafson. He estimates that once a complaint is filed, a case can be investigated and resolved in 30-60 days.

“I wanted to get involved in organized dentistry and help fellow dentists and patients. It’s also very educational. Every meeting I go to, I look at a case and get that much more insight to bring back to our practice,” he adds.

Here’s how it works:

• Dr. Gustafson says his job on the peer review committee starts when communication between a patient and dentist stops.

• “At that point the patient or the member dentist (peer review committees only mediate disputes if the dentist is an MDA member) contacts the MDA.” Complaint forms are available by calling (517) 372-9070, or (800) 589-2632.

• Once the complaint is filed, the dentist sends his or her records for the patient in question to the MDA, which forwards the file to the local peer review committee. “I wouldn’t want anyone to think we’re inundated with cases,” Dr. Gustafson says. “We meet as a committee once a month. Last year we probably only saw 20 cases. When you think of how many people live in Oakland County, and how many dentists are practicing here, that’s a very low complaint number.”

• The case is assigned to a specific member of the peer review committee. “We investigate. Often it can be handled thoroughly, successfully and to everyone’s satisfaction over the phone. We’ll call the patient, then call the dentist.” Often, Dr. Gustafson finds the cases hinge on poor communication between the patient and dentist, and not necessarily on poor dental work.

• In-person interviews are the next step if the case couldn’t be resolved over the phone. “There are three dentists on the panel. Each of us will study the case, then each dentist will examine the patient, and finally each of us will talk to the dentist.”

• “After that, our job is to decide if the complaint is valid or not. If it is, we seek to have the work redone or get a refund for the patient. This relates strictly to the actual price or service – we do not fine, we do not assess punitive damages,” Dr. Gustafson says.

• The last step is sending the finding and file back to the MDA, which returns the patient’s file to the dentist and informs the patient of the committee’s decision. “We’re very careful with those files, particularly as they relate to a patient’s privacy,” Dr, Gustafson adds.

The majority of the cases that come before peer review involve ill-fitting dentures or misdiagnosed/undiagnosed cases of gum disease. “If you’re doing standard-of-care in your office, you can’t miss gum disease,” Dr. Gustafson says. Standard of care means the dentist provides thorough and precise care of the patient by keeping up with the latest techniques and by not skipping steps in the examination process.

Dr. Gustafson emphasizes the dentist must be an MDA member to take advantage of peer review. “That’s a benefit to the dentist and patient.

“For example, it means neither side has to hire an attorney. Say you’re unhappy with a crown – that’s the cost of an attorney right there,” Dr. Gustafson points out. “It’s also non-confrontational, which is personally important to me. It’s tells patients we are willing to police ourselves as professionals and seek prompt, fair resolution of complaints on their behalf.”