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Dealing with a difficult patient

08 January 2019

Difficult interactions can be distressing for both patients and members of the dental team. They can be a catalyst for complaints and claims,  but dealing with them effectively can lead to a better outcome for patients and members of the dental team.

Avoid preconceptions

A brief scan through the names of patients on your morning list may reveal a few that are familiar – and not always for positive reasons. It is likely that you will form a very quick assessment as to how challenging the forthcoming clinical encounter will be, based largely on your previous contact with the patient. In some cases this may be clinically related, or it may be because you have already labelled the patient as ‘difficult’ due to their behaviour at a previous appointment.

Once you have made this assessment then it becomes easy to stereotype or label a patient and make assumptions about them. Our perception of difficulty can then affect our greetings, body language, the degree to which we listen and the information we provide. This can make the consultation increasingly difficult. A consultation is a dynamic, interactive process, with both patient and healthcare professional responding to each other’s behaviours.

Managing an incident

Difficult interactions don’t only take place in the consultation room. Patients can behave in an aggressive manner towards administrative or nursing staff. If an incident arises that you are not witness to, it is wise to seek a clear understanding of what has taken place as quickly as possible. It is important to offer support to staff, but also to request a written, contemporaneous statement of events.

Once the situation is understood, the patient should be approached at the earliest opportunity by an appropriate person – for example the dental practice manager. Enough time should be set aside to have this conversation and a record of the exchange should be kept.  Sometimes, having the conversation with the patient can defuse the situation and the patient may accept that their behaviour was inappropriate.

Terminating the relationship with a patient

It is entirely understandable that following a difficult interaction one of the first considerations is whether or not to remove the patient from the practice list. If it is decided to no longer see a patient who is currently under treatment, then as far as possible arrangements should be made to transfer the patient’s care or offer a referral to a colleague. If patients display violence to any member of the practice staff or are threatening to the point where there have been fears for personal safety, Dental Protection would recommend that the incident should be reported to the South African Police Service.

Defuse a difficult interaction with:

  • a warm, friendly greeting and a smile
  • eye contact and open body language
  • active listening, with open questions and no interrupting the patient
  • exploration of the patient’s values, concerns and preferences
  • discussing all options and offer explanations
  • involving the patient in the decision-making.

Outcomes from difficult interactions include:

  • increased investigations and referrals
  • decreased patient satisfaction
  • unmet expectations
  • increased dentolegal risk