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Case Study: Bhopal Gas Tragedy - Communication Failures #2

Rachel Ruddy, a fifty year old mid-manager at the City Bank of New Rochelle, has been considering for quite some time having some extensive dental work. Although she made a point of having yearly checkups and cavities filled, she felt her appearance was affected by a badly discolored incisor, misaligned teeth and noticeable fillings. In the growing awareness of the self image and its relationship to job mobility, she decided to invest in having her teeth crowned.

She enlisted the professional services of her regular dentist, Dr Luke, who also happened to be a casual social acquaintance with whom she shared some friends and interests in common. Her first step was to ask Dr Luke about possible improvements. He explained that he would initially take an impression and then discuss a total diagnostic package. The cost of her phase would be $75, a charge to be subtracted later if she chose to have the work done.

After completing the impression, Dr Luke, explained the total procedure to Rachel at a professional appointment. She was so shocked at the initial figure ($4900 for the work that she assumed would cost half the amount) that she asked a few questions at that session, hesitant to pay so much just to improve her appearance.

Later upon reflecting upon the importance of her job and her desire never to have dentures, she returned to another appointment to clarify her understanding of the process and charges. Most of her questions dealt with the process itself.

From this appointment she understood that the charge included five years of maintenance. In fact, Dr. Luke mentioned that at one time he offered ten years, but found that figure unrealistic. He stressed that the decision to have this work done was the patient's. But he did mention that saving one's teeth and avoiding later problems with the temporomandibular joint were investments. And of course, if one compared the cost of that to a new car, it did not seem exorbitant.

Rachel had the work done, but she found that the diagnostic fee was not subtracted from her bill. The doctor's billing secretary maintained that Rachel misunderstood the initial figure and the doctor had already subtracted the fee. Rachel did not believe that he had done so, but decided that it was not worth making an issue of $75.

A year later, however Rachel was billed $20 after a regular appointment with doctor's regular hygienists. When she protested this charge, she was told that she had misunderstood. The package was for one year maintenance, but certainly a reasonable person would not expect to have 'free' dental care for five years. The five year period was for replacement of crowns that may not have adapted to the mouth.

Rachel had no intention of going to court or changing dentists. She was fairly satisfied with the work, but not with the colouring of one tooth. Luke had told her not to worry as within a year the shading would conform through natural staining. He had been right with other predictions about the teeth, but she was uncomfortable thinking that if she waited too long she might be charged for any changes and new crowns.


1. Who was at fault—the dentist for not putting his diagnosis in writing or the patient for not fully understanding the services?

Here the dentist was at fault, since he didn’t put his diagnosis in writing. Though the patient tried a lot to understand and she was satisfied also by dentist dialogue but there were so many people associated with this and almost all of them were giving different statements. That made the patient more and more confused.

2. How could some of these misunderstandings have been avoided?

By providing a solid written document, that consist of the service policies in details could have avoided these misunderstandings.

3. What services should have been communicated orally and what ones in writing?

The services that should have been communicated in written are:
  • Diagnosis fee
  • Maintenance fee
  • Visiting fee
  • Visiting sessions date & time
  • Diagnosis brief
  • Package in details
  • Duration of diagnosis
  • Maintenance period

The services that should have been communicated in orally are:
  • Diagnosis in detail
  • Package in brief
  • Fee estimation
  • Pros & cons of diagnosis
  • Suggestions
  • Socializing statements


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