Peer Review

Dentistry’s Dispute Resolution Program: A 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 (and sometimes laypersons) 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 through review of patient records. 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 to 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 is 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.

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 and the dentist, and for 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 dentist and a patient and their mutual interest in good dental health.

Should you wish to know more about peer review, please contact your local dental society.

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 along 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.

(The information in this article 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.)

©1999 American Dental Association

For more information on peer review, please visit the American Dental Association’s Peer Review web page.

Downloads:

ASDA’s Mediation Request Form

ADA’s “How the Dental Peer Review System Works and What to Expect From It

ADA’s Peer Review Manual “Peer Review In Focus – Dentistry’s Dispute Resolution Program: A Peer Review Process – A Complete Guide to the Process and Related Considerations

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