STAFF RX: The angry patient

Unpleasant situations like this always make us feel uncomfortable, because we feel we have done something to elicit this negative behavior.

May 1st, 2001

Dear Dianne,
I had a very unusual experience with a patient recently. The patient, a male in his mid 50s, was new to the practice. I seated him in my chair as usual and introduced myself. As I went over his medical history, I noticed that he seemed irritated and rather unfriendly. When I asked if he had any dental concerns, his short reply was, "Nope!" I reclined the chair and began my intraoral exam. He had numerous old, discolored restorations and several crowns, although I did not see any overt decay. It appeared to me that he had received adequate dental care in the past, although I did note several teeth with fracture lines.

When I began my periodontal probing, his irritation escalated. I asked the patient if the probing was uncomfortable, and his reply was, "No, just get it over with!"

At this point, I was beginning to wonder what it was about me this man did not like. I proceeded to do his prophylaxis in silence. I told the doctor privately that the patient seemed unhappy and irritated, but I had no idea why.

After the doctor did the exam, he informed the man that two teeth needed crowns, because the huge fillings in both teeth appeared to be fractured. We showed him the images of the teeth with the intraoral camera. The man was basically unresponsive and merely shook his head when the doctor asked if he had any questions.

When I escorted the patient out to the front desk, it was obvious he was angry. I was clueless as to why he was reacting this way. He paid his bill and stormed out the door without making an appointment.

I do not feel I handled this patient well. Could you give me any advice on dealing with an angry patient in the future?

Baffled in Buffalo

Dear Baffled,

I suspect some problem was eating at this patient before he arrived at your office. An astute front desk assistant can often detect when patients arrive in a foul mood and should apprise the clinician.

This sounds like a patient who has a history of some previous unpleasant dental experience. He is probably convinced that whatever bad experience he had in the past is characteristic of all dental offices. In other words, he is using transference and expecting the worst.

As clinicians who work in very close proximity to our patients, we should be very sensitive and attentive to our patients' nonverbal communication. Before reclining the patient when you first sensed that all was not well with him, you could have asked this question: "Mr. XYZ, how do you feel about coming to the dentist?"

If he tells you that he absolutely hates to come, you may be able to help by inquiring about any bad experiences in his past. By knowing his fears and frustrations up front, you can make adjustments in the visit to show him that your office is not like other offices.

It is important to acknowledge patients' nonverbal expressions, whatever they may be. This patient was obviously telling you with his body language that he was unhappy.

You could have said, "You seem irritated. Has anyone here done anything to make you feel this way?"

From this question, you may be able to determine if he arrived with heavy emotional baggage that has nothing to do with your office. If there is a problem at the front desk with how he was received initially, he may tell you about it. Problems of this nature should be brought to the doctor's attention privately.

It is possible to rub patients the wrong way with our own verbal and nonverbal communication. For example, sometimes we are so caught up in our own problems that we are not attentive and sensitive to our patients. We appear indifferent when we ignore their obvious expressions of pain, frustration, irritation, or anger. Another example is when we attempt to sell the patient on some dental procedure that he/she is clearly not interested in obtaining. Although it is appropriate to talk dentistry (and I encourage hygienists to do so as their employer desires), we must not try to force the issue with our patients. Attempting to continue a conversation when the patient is clearly not interested is counterproductive in every way.

Unpleasant situations like this always make us feel uncomfortable, because we feel we have done something to elicit this negative behavior. We tend to personalize the reaction. The fact is that many of the problems our patients are carrying have nothing to do with us personally.

If you can "kill" the patient with kindness, you may be able to win him over. The first step is to discover what is making the patient feel as he does. Once you discover the problem, you should be able to empathize. However, if the patient refuses to open up to you, there is little else you can do.

When your patient displays negative emotions, use generous amounts of caring and understanding. A good question to ask at the end of the visit and before the patient is escorted to the front desk is, "We appreciate having you as a patient. Please tell me what we can do to make your future visits more pleasant." Sometimes patients will relax at the end of the appointment and are more willing to communicate.

If you stay in dental hygiene very long, you are bound to have an angry patient occasionally. Knowing how to deal with other people's anger will help you maintain positive communication.

Dianne

Dianne Glasscoe, RDH, BS, is an adjunct instructor in clinical hygiene at Guilford Technical Community College. She holds a bachelor's degree in human resource management and is a practice-management consultant, writer, and speaker. She may be contacted by e-mail at dglasscoe@northstate.net, phone (336) 472-3515, or fax (336) 472-5567. Visit her Web site at http://www.professionalden talmgmt.com


D*E*F*U*S*E the angry patient:

Don't lose your cool. Remember, no matter how angry or irate the patient gets, you must remain calm. If you lose your temper or start arguing with them, you cannot concentrate on the true problem. One-sided arguments will eventually die out, but if two people are arguing there may be no end to the confrontation. Instead of having negative thoughts like, "Why me?" or "I can't handle this," be positive and take the attitude that you can find a solution to the patient's problem.

Maintain a neutral face and a level voice.

Encourage patients to vent emotions. When a patient is expressing their emotions, be tolerant. Let the individual vent those feelings. Do not make the common mistake of pushing ahead when the patient is obviously upset. If patients are allowed to discuss their problems, they will be much more likely to provide the necessary information. Some keys to remember when a patient is expressing his/her feelings:

  • Don't be tempted to rush the patient. Rushing makes you seem unsympathetic.
  • Express empathy and apologize for the mistake.
  • Give the patient your full attention at all times, and do not let communication wander.
  • You do not need to make them right, but do not make them wrong. "I understand your feelings." "I'm sure if I were in your place I would feel the same way."

Find out the facts. The best way to come up with a solution to a problem is to find out all the facts. Get as much information about what happened, what was expected to happen, and what expectations were not met. When a patient begins explaining the situation, here are a few things that can be done to help find out all the facts.

  • Take notes.
  • Feed back what you hear. "No one called you back that day, is that right?" "It sounds like this entire experience was extremely frustrating for you."
  • Remove all distractions.

Do not be afraid to ask the patient anything and everything about the problem. With all the facts in front of you, it is time to begin working toward a solution.

Understand your patient's feelings. Assume the patient has (in his or her own mind) a legitimate reason for being upset and then listen for what it is. If you find yourself labeling the patient as a troublemaker or someone who does not know what they are talking about, stop and think about the last time you received poor service or felt you had been wronged.

Suggest a way to resolve the problem. After all the facts have been gathered and the patient has expressed his feelings about the situation, the problem needs to be solved. You must now inform the patient what you intend to do. The solution must be conveyed clearly and concisely, using language that the patient understands.

Unfortunately, there are times when the solution to a problem is simply out of the question. When you find yourself having to say "no" to the patient, here are some points that may soften the blow:

  • Apologize, and then explain to the patient why his/her wishes cannot be fulfilled.
  • Hear out the patient's response when you tell him "no." The points the patient brings up may be valid ones and if you continue to hear the same complaints, you may want to see if something can be changed.
  • Provide the patient with an alternative. Don't just tell the patient what you can't do, but tell him what you can do.

End on a positive note. Once you have discussed a solution with the patient, make sure their problem has been or soon will be resolved in a satisfactory manner. Let the patient know how much you appreciate his business, and do everything possible to assure the patient that the situation will be resolved.

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