Putting out patient fires

Aug. 1, 2000
Learning how to douse the flames of patient conflicts before the fire gets out of hand is a simple, four-step process.

Learning how to douse the flames of patient conflicts before the fire gets out of hand is a simple, four-step process.

John A. Wilde, DDS

Most hygienists can function beautifully when the day runs smoothly; the office is peaceful; and the work is productive. However, as surely as "into every life a little rain must fall," conflict will appear — even in the most sophisticated and patient-friendly hygiene departments.

I`ve heard "mastery" defined as "the art of exhibiting excellence under pressure." Your ability to deal with avoidable strife in a calm, confident, and positive manner — behavioral mastery — augments your chances of achieving professional success, peace of mind, and happiness.

Office problems assume many forms. But most of us would agree that conflict with patients is a classic no-win situation. Even if you are "right," you will be tried and found guilty in the patient`s court of opinion — from which no appeal is possible. An upset patient might not return for needed care. This patient also will not refer his or her friends and may even disparage the hygienist or the practice within the community.

If you agree with me that it is impossible to win such confrontations, then it`s time to consider the ideal way to handle conflicts for the best possible outcomes. To that end, I`d like to share with you a concise, four-step formula that will allow you to face contention with proficiency and aplomb.

Putting it all together

Let`s look at a sample scenario using the four tools described above. Mr. Entrepreneur may be a really nice person, but he is far from an ideal patient. He accepted the soft-tissue management program your office suggested four years ago, but he has refused to buy the oral hygiene instrument you recommended. ("Just an expensive toothbrush!") He has canceled, failed, and rescheduled appointments so often that the suggested three-month recalls have become closer to six-month intervals. In addition to being a heavy smoker, Mr. Entrepreneur is difficult to care for clinically, due to extreme anxiety, a strong gag reflex, and the fact that he has sensitive teeth (not to mention bad breath that would gag a garbage collector!).

It has been seven months since his last visit. Today, he strides into the operatory 10 minutes late. He loosens his tie and advises you he has to be in a meeting within the hour. A quick probing reveals increased pocket depths, heavy bleeding, areas of purulent exudate, and increased mobility of his teeth. It`s time to forthrightly address this patient`s declining oral health.

Three critical steps reinforce he delivery of any important message to a patient:

- Make firm, direct eye contact with the patient.

- Address the patient by an appropriate name.

- Initiate some form of physical contact with the patient.

You upright the patient`s chair, reach out and lightly touch his shoulder, look him unwaveringly in the eye, call him by name, and reveal your findings. You explain their significance and suggest that a referral to a periodontal specialist would be in his best interests.

"Are you telling me that all the time and hard-earned money I`ve invested in treating my gum problems with your office has been wasted?" Mr. Entrepreneur asks. "And now you want another dentist — one I don`t even know — to take over my care? What is wrong with you people?"

What follows is a continuation of your patient`s one-sided dialogue. When you know you`ve done your best, it`s difficult to listen to Mr. Entrepreneur`s tirade. But behavioral mastery consists of excelling in just such unfair and unpleasant situations. So, you listen calmly and patiently, maintaining eye contact (no guilty glances at the floor). You provide feedback by nodding understandingly and trying to slip in an occasional "I see" when your patient pauses to catch his breath.

When he seems to have run out of steam, it`s your opportunity to jump in and say how sorry you are that the most conservative approach to his problems — the one you would try first for yourself or a loved one — has not been successful, despite your best efforts. Tell him that you will continue to do everything within your power to help maximize his oral health, but that additional assistance is needed now. (You might add that the good news is that dentistry has more potential treatments for his problem today than it did even four years ago.)

In the situation I`m describing, it`s easy to take the road most traveled - to officially say that due to the missed appointments, the patient`s continued smoking, and his poor oral hygiene, your best efforts have little chance of success. These statements are all true, but fixing the blame doesn`t fix the problem! Reacting defensively, no matter how justified it is, is liable to result in the patient angrily leaving the practice, not receiving badly needed care, being critical of you and the office - or worse yet, even seeking legal recourse!

When the patient`s emotions are under control, it`s time to co-develop a plan of action. Assure Mr. E that he won`t be abandoned. Reinforce that your office will continue to support him to help him resolve his periodontal problems in the best possible manner.

No one - no matter how behaviorally skilled - can control the actions of another. Nothing you say or do can guarantee that Mr. E will be satisfied. But, choosing this adept pattern of action can assure you that you have continued to do your utmost behaviorally for this patient, just as you have clinically.

The anger and anxiety that might have troubled you for days had this predicament erupted into a direct confrontation will be replaced by a feeling of tranquility that accompanies the knowledge that you have done your best.

John A. Wilde, DDS, is the author of four books, including the recently released Dentistry`s Future. Currently, he is an associate editor with The Profitable Dentist newsletter. He can be contacted by phone at (217) 847-2816 evenings or weekends.

Fire prevention tools for patient conflicts

1. Listen

When faced with any form of conflict, the first step toward a positive resolution is to carefully listen to the complaint and agree with the complainer. Show patients with brief verbal feedback — and with your body language — that you sympathize with their problems and that you are on their side.

To do this, you must stifle the natural urge to justify yourself. Make a determined effort to focus on listening to this unhappy person — not on your own raging, defensive internal dialogue. Let the patient know how disappointed you are that he or she is upset. When patients are displeased, I am saddened. Just saying, "I`m terribly sorry you are upset" is not an admission of guilt.

2. Remain on the patient`s side

This is the key to draining energy from even the most vociferous complainer. It`s difficult for an unhappy patient to continue protesting with a hygienist or dentist who keeps agreeing with this individual`s every statement. Don`t leap to a possible solution, but do allow the patient every opportunity to vent — both words and emotions — completely. Remember that an infected wound must be thoroughly drained to heal cleanly.

3. Immediately accept full responsibility for the problem

This doesn`t mean you caused the problem. Rather, it assures the unhappy patient that you possess the necessary integrity and personal power to set things right. There`s an overabundant supply of "it`s not my fault" within our current culture.

Consider this: When you are faced with a problem, is it excuses you want to hear? Or, do you long for a White Knight to appear, assume full accountability, and set things right? Someone embracing responsibility is comforting to the person with a problem. Directly facing unpleasant situations is the mark of a mature person — a champion!

4. Co-develop a plan of action

Once you and the patient clearly are on the same side of the issue and the patient has been allowed to release his or her emotional energy, it is time to calmly co-develop a plan to deal with the situation in a manner acceptable to both of you.