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Breaking through the barriers

April 1, 2009
Difficult patients are a communication challenge
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Difficult patients are a communication challenge

by Suzanne Hubbard, RDH

Lynn* is a 50-year-old teacher who makes her way to my chair every six months. Our conversations consist of my asking her questions about her job, her kids, and her life in general. Mind you, I ask open-ended questions, but all I seem to muster from Lynn and our conversations is a simple “yes” or “no.”

* Kent is an 84-year-old retired Marine. He also sees me every six months without fail. His first words are always, “It's so cold in here.” He proceeds with the same conversation each visit about how nothing is right in the world. The temperature of the room is just a small inconvenience. He doesn't like the sound of the slow speed handpiece. He tells me he writes to the local newspaper to complain about issues at least once a week.

*Ruth is a 38-year-old mother of three. She sits down for a cleaning and asks that I only take 15 minutes because she's in a hurry. She moans and groans if I exceed the 15-minute time frame. She also doesn't like the environment. Nothing I do is ever right. Anything I say is negated and questioned.

We face situations and confer with people like these every day. It seems nothing we say or do can remedy the situation. For whatever reasons, certain patients put up a wall or a barrier. We know that in our jobs, conversation is a very important factor. For me, it is probably one of the most appealing parts of the job. Not only do I get to know patients, but I can help them toward better health. It allows us as clinicians to break down the barriers of fear, and replace those fears with trust and honesty. Open conversation helps us communicate effectively. When patients are open and receptive, we find that their oral health is better because they have heard, processed, and acted upon our information.

We won't be able to please everyone, but we can try. Remember Lynn, the teacher? She is one of those patients with whom I worked and challenged myself to break through her barrier. By all accounts she was not friendly. As soon as she sat down in my chair, her headphones went in her ears and she turned on her iPod. Having a conversation around earphones was impossible. I still tried. Her one word answers always left me feeling cold toward her, and I'm afraid she felt the same way. When I would see her name listed on my schedule, a sense of drudgery filled my heart and mind and I'd cringe.

Today she was on my schedule. I started our conversation as I had every other time, discussing her children. “Lynn, how's your son, John? I saw him not too long ago at the library.” Stone silence, and seconds later a one word answer. I saw her pull out her iPod and start fiddling with her earpieces. I felt a challenge coming on, so instead of shrinking back, I continued to ask her questions, this time hitting on a single focal point — her passion. Teaching is what Lynn does. She loves it! So off we trailed on an hour-long conversation about teaching. Lynn talked about her daily teaching plans, the colors in her classroom, and the kids she loves and teaches. All of a sudden, her one word answers became long sentences filled with laughter! Our conversation opened up. I used to tread lightly when talking to Lynn about the status of her oral health. In the past, she didn't want to hear about it, and she'd close a conversation before it even began. Today she wanted to hear about it, and even asked me to help her learn how to use soft picks correctly! Her iPod sat on her lap during that appointment. It's taken me a year and a half to break through her barrier, but it was worth it!

I have come to realize that our patients present to us in many forms. When they step into our operatories, it isn't a vacuum. Illness, death, the suffering economy, loss of jobs, and loss of relationships all affect our patients' emotions and behavior. They come to us and are often broken, discouraged, and exhausted. We also have to remember that sometimes we are just another item to check off on the to-do list.

And there are still those we will never please!

*Karen, a 40-year-old stockbroker, was new to our office. She stated this was her fourth dentist in two years. Why? No one could help her with her oral health. During our conversation, I asked Karen how we could provide for her oral health, how we could make her experience better and continue to receive her patronage. She couldn't identify anything in particular that was amiss in her last few dental appointments. She simply stated she wasn't satisfied. Karen seemed fine with her cleaning, exam, and overall experience. She went so far as to say that it was a great experience. When our office manager came back later, I was told that Karen felt the staff was rude and that she would be looking for a new dentist.

Everyone experiences a Lynn, a Kent, a Ruth, and even a Karen. These are patients we simply tolerate, and quite honestly, we feel relief when they leave our chair. Sometimes we can do nothing right, try as we may. We go out of our way to make sure the patient has a good experience. In addition, some may take years to develop that special rapport. Remember Kent, the Marine, and one tough cookie? I now greet him with a warm blanket. I realize for him the atmosphere still isn't quite right, and one day he may go so far as to complain about this dental office and me in a letter to the local paper. I may never break down his barrier, but I sure am going to give it a try!

* Not the patients' real names