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Winner takes all – dealing with a patient challenge

11 December 2018

As clinicians, we diagnose and treatment plan with our patients’ best interests at the forefront of our mind. It can therefore be incredibly distressing when a patient challenges us and states we are “going about it all wrong”. What do we do then? Dr Annalene Weston, dentolegal adviser at Dental Protection, asks if we can ever really win an argument with a patient

The best relationship a clinician can ever have with a patient is one based on mutual respect and trust. Regretfully, many patients approach this budding relationship with mistrust and resentment: while we, the clinicians, understand the mechanisms of dental disease, and the steps that can be taken to both prevent and mitigate this, many patients view their dental disease as bad luck or inherited.

Consequently, many patients have a tendency to view all dentistry as a distress purchase. To compound this distress purchase further, the clinician then has the ‘audacity’ to suggest the patient owns their own disease and manages their own health. For some patients this is simply too confronting to tolerate, and well-intentioned dietary and oral hygiene advice quickly deteriorates in their mind to the level of insults and personal slights, putting them further offside.

In response to this ill-feeling, some of us may adopt an unhelpful protective stance, enriched by a sense of rightness and righteousness. Others may retreat into themselves, their fight or flight reaction fully engaged, and fearful of the challenge that may follow. Naturally, some of us miss this opportunity to recognise the tension boiling below the surface altogether, and drive forwards undeterred on our mission to improve the patient’s health and wellbeing, with or without their co-operation.

When a complaint arises

When a relationship is unravelling as described above, it will almost always end in a complaint being made by the patient against the clinician. The unfairness of this can seem immense, particularly when you have taken all possible and reasonable steps to help the patient.

Before the complaint is formally submitted, there is often a moment in time when the clinician and patient begin to grapple: both with the facts and with the truth. Embedded within this moment of time is an opportunity to resolve the conflict, maybe to even get the patient onside. But often this opportunity is missed, as we are blinded by our deep-seated desire to be right.

Right or wrong?

It is not unreasonable, after all, to want to be right. Our self-worth as clinicians is often validated by our ability to be right – from the qualifications we achieve, to the successful way in which we care for our patients. When we reflect on past altercations with patients, could it perhaps be that, on occasion, we have let our desire to ‘be right’ overpower our need to resolve the matter amicably with the patient? Can we ever truly win an argument with a patient if they believe us to be wrong?

Realistically, no we can’t. We may have the short-term satisfaction of ‘putting the patient straight’, but this satisfaction quickly falls away when the patient counters with a formal complaint to our regulator, along with all of the time and stress that responding to and resolving this entails.

Perhaps, rather than considering our difficult patient interactions in terms of ‘who’s right and who’s wrong’ or ‘who wins and who loses’, we instead need to focus on patient needs and values, and recognise that if we cannot meet them, we need to direct the patient to a colleague who can. We may not experience the short-term gratification of a righteous victory, but we will likely avoid the long-term heartache of a formal complaint – making it a fair trade-off.