1610rdhcmorr P01

Morrissey: Do we do a disservice to dental patients when we 'soften the blow'?

Oct. 18, 2016
Eileen Morrissey, RDH, questions why dental patients would not want to know the whole truth about treatment.

By Eileen Morrissey, RDH, MS

Why do we sometimes feel the need to "soften the blow" in our communication with people? I know I have been guilty. Perhaps softening the blow is good at times, unless it manages to dilute the message we are attempting to convey.

As an example, a dentist I know of has just informed his patient at the close of her recare visit that #3 needs a crown. She was unaware, as there had been no discomfort, breakage, or roughness. Yet the tooth was in danger of fracturing in a way that could necessitate an extraction if restoring it was not prioritized. The dentist explained the need, and the patient appeared to accept treatment. He went on to say, "As you may or may not know, Mary, the crown requires a couple of visits."

The dental hygienist who shared this story with me says her hair stands on end when she hears her doctor say this, which is almost every time he treatment plans a crown. Understand this is a traditional crown preparation, which will ultimately require three visits. Why then, would he tell the patient she would only need to return twice?

I believe it is because he feels this patient may feel inconvenienced by having to return to the office three more times. Presenting that only two are required may make her be more accepting? Perhaps he can reconcile that the two initial appointments are the working visits, and the final is when the crown is presented and cemented-a short, sweet, and happy event for the patient.

The doctor is softening the blow and minimizing what he perceives as confrontation. Ultimately, the patient goes to the front desk administrator who sets up the two initial appointments. Since a final visit is scheduled when the lab returns the case, that appointment cannot be made in advance. Let's assume the patient will be tired of her temporary and in anticipation of receiving the new one.

I don't really get it. If I were that patient, I would want to know what the total treatment protocol would involve up front. In fact, I'd be mildly annoyed if I remembered having been told I would only need two visits. Yet this hygienist reports that, while her doctor perpetuates this customary explanation, his patients continue to love him, and nobody seems to complain. She chooses not to ask him why he does it.

In looking at a dental hygiene scenario, my patient has a breath problem, but I don't have the heart to inform her directly. I find a way to sneak through the back door by telling her that I'm noticing an odor as I scale between the two upper right molars. I say that I'm fearful this may be impacting her breath overall. I'm softening the blow, making the message gentler in the hopes of not hurting her feelings and counting on her being more receptive to the information. Is that so terrible? Sigh. What if I'm softening to the point where she fails to perceive the severity of her issue and does not worry about addressing the problem? I've done her a disservice. Not good!

A final soften-the-blow example might be when someone chooses to write a note to someone about an issue rather than to speak of it to the person directly.

A dental assistant I worked with didn't like the fact that I would leave an ultrasonic container in a particular location. She left a neutral note on the container asking that it "please be placed" on a newly designated shelf after disinfection. (I assume it was easier for her to instruct me in that fashion so as to avoid a direct verbal confrontation.) It was her way of softening her scolding of me. OK!

In his book, "Professional Leadership in Schools," James Williams writes about the obstacles to effective communication. He states: "... no one relishes giving bad news to others ... in an attempt to soften the blow, we can make the mistake of delivering only part of the message. We may leave out information, which at a later date, comes into the open resulting in a worsening of the situation."1

This statement would be relevant to the aforementioned doctor who downplays the number of office visits necessary for a crown, as well as for me when I am not straightforward with regard to the magnitude of my patient's halitosis.

Mr. Williams also wrote, "Keeping back information will not help. It is far better to be open, honest, impartial, and most importantly, supportive if the information you have to communicate is bad."1 He contends that often, the bad news does not come as a surprise to the person being informed. It is our own preconceived notions that have us thinking the impact is going to be negative.

As far as the displaced ultrasonic container, I never quite understood what difference the location made. I decided that this assistant was not interested in a one-on-one discussion. I choose my battles, and this was not going to be one of them. From that day forward, I made certain that container landed in its newly designated home!

Onward we go; it is in our hearts' core! RDH


1. Williams J. Professional Leadership in Schools. Taylor and Francis, 2002. p 64.

EILEEN MORRISSEY, RDH, MS, is a practicing clinician, speaker, and writer. She is an adjunct dental hygiene faculty member at Burlington County College. Eileen offers CE forums to doctors, hygienists, and their teams. Reach her at [email protected] or 609-259-8008. Visit her website at www.eileenmorrissey.com.