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Mastering difficult interactions with patients

05 July 2019

We share some top tips to effectively manage difficult interactions with patients, including avoiding them in the first place. Feedback has shown these essential skills – which are also taught on Dental Protection’s ‘Mastering Difficult Interactions’ workshop – are valuable to members. 

Dentistry requires working with a range of people when they are often feeling anxious and vulnerable. When anxious, scared or in pain, adult patients can behave in a regressed or adolescent manner. This loss of internal ‘locus of control’ can result in strange behaviours and demands. It is therefore not surprising that difficult conversations and situations arise. Dentists can inadvertently contribute to making interactions difficult through a range of factors – some of which are identifiable and correctable.

Difficult interactions can have a negative effect on patients and dentists and can be a contributing factor for burnout amongst dental professionals. They are also a common catalyst for complaints and claims.

The following top tips – discussed in more detail at the workshop – identify some preventable factors of difficult interactions and how to manage them.

1. Avoid HALT – Hungry, Angry, Late and Tired

Develop rituals to ensure you eat and drink regularly throughout the day and have a cap on numbers of patients you feel safe to see in a given time period. You should not go to work when unwell. Your surgery or organisation should have policies and protocols in place to support these evidence-based safety strategies.

Dental Protection’s workshop, Building Resilience and Avoiding Burnout, provides further advice.

2. Respectfully correct unrealistic expectations

Unmet expectations lead to disappointment for both the patient and dentist. Patients have preferences and expectations about all aspects of healthcare. So do dentists. When disappointed, it is easy to blame the other, rather than share the disappointment. Developing skills in how to disappoint patients safely is very useful. It is essential to: 

•  Recognise an unrealistic expectation – ask about expectations and listen carefully to the answer.

•  Acknowledge the patient’s disappointment.

•  Request permission to explain the situation logically.

3. Avoid labelling the patient

Recognise regressed behaviours in anxious patients and reframe these to avoid labelling a patient as ‘difficult’ or ‘demanding’. Viewing a set of behaviours triggered by the dental event as temporary can help our empathy and compassion flow, enabling us to see beyond the behaviour and ensure a good outcome for all. Many patients apologise after the event and develop huge respect for dentists who can contain their regressed behaviours safely.

4. Understand Body Dysmorphic Disorder (BDD)

Develop a strong knowledge base around BDD and have a protocol for screening and supporting these patients. The prevalence of BDD in those seeking dental interventions is high; estimates vary between 2% and 28% in the general population, but it is probably at least 10% of dental patients.1 Up to 1 in 5 BDD patients specifically report dental concerns.

It is important for cosmetic dentists to consider psychiatric referral for such patients.2 Treating patients without recognising underlying BDD is risky. These patients often remain unsatisfied and will request more and more treatment. These vulnerable patients can often be highly litigious.

5. Develop robust negotiation skills

Dentists and patients each have a ‘band of comfort’ on possible diagnoses, appropriate investigations and management options. Difficulty can arise when there appears to be no overlap in these bands of comfort. If you do not have strategies for negotiation, this commonly leads to conflict. The AID© model is a simple negotiation model that can help in these risky situations:

•  Acknowledge the patient’s view.

•  Inform the patient of your view .

•  Discuss a way forward.

Workshop for members

The Dental Protection ‘Mastering Difficult Interactions’ workshop is designed to give dental healthcare professionals competence in handling difficult patient interactions. This practical 3 hour workshop presents the AID© model and examines techniques to help reduce stress.

The workshop is free to attend for members and can be booked via Prism.

References

1. Scott SE, Newton JT. ‘Body dysmorphic disorder and aesthetic dentistry’ Dent Update 2011. 38(2).

2. Winfree WJ, Rouse LE, Brown RS. ‘Body dysmorphic disorder and cosmetic dentistry: diagnostic, management, and ethical issues’ Dent Today 2014. 33(3):72–4.

Please note: Dental Protection does not maintain this article and therefore the advice given may be incorrect or out of date, and may not constitute a definitive or complete statement of the legal, regulatory and/or clinical environment. MPS accepts no responsibility for the accuracy or completeness of the advice given, in particular where the legal, regulatory and/or clinical environment has changed. Articles are not intended to constitute advice in any specific situation, and if you are a member you should contact Dental Protection for tailored advice. All implied warranties and conditions are excluded, to the maximum extent permitted by law.