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Difficult conversations in difficult situations

Post date: 04/05/2022 | Time to read article: 6 mins

The information within this article was correct at the time of publishing. Last updated 04/05/2022

Evelyn Ferguson-Williams, Case Manager at Dental Protection and former dental nurse, looks at the communication skills required for challenging conversations in the workplace.

As a dental care professional, you play a vital role in ensuring a patient’s care is as safe and satisfying as possible. Part of that role requires you to undertake some difficult conversations. These conversations can be due to a variety of reasons, and not only involve patients but also their partners, parents and carers, and our colleagues in the practice team. This article will guide you through what we may consider a difficult conversation. 

What makes a conversation difficult?

There is no hard and fast rule as to what constitutes a difficult conversation. We are all different and what I may consider a difficult conversation, my fellow peers may find much easier. How we are feeling on a particular day may also interrupt our ability to face a more challenging conversation. A sleepless night, a troublesome journey to work or even feeling a little under the weather could all be reasons we may struggle to tackle a difficult conversation. 

Due to human nature, it will always be difficult to break bad news, even for the most experienced and skilled communicators. In dentistry, there are times when we regretfully must deliver negative and on occasions life changing news. That aside, there are four factors that may interplay and determine how difficult a conversation may turn out to be.

Patient factors

Regardless of what role we play in the dental team, there are many different ‘patient factors’ that come into play during a conversation. As we all know, many patients have an overwhelming fear of the dentist and the surrounding environment, which can understandably make communication tricky. You may find it’s useful to speak in ‘layman’s terms’ to a patient, as technical speak may hinder successful communication further and result in unwelcome confusion. 

There is also the possibility that English is not a patient’s first language, which causes communication obstacles of its own. There can be no doubt that some cultural barriers can also exist when it comes to having a conversation with a patient, and it’s important to take the time to understand any appropriate cultural needs as best you can, particularly if the culture is one you have not experienced before. 

Some communication issues relate to the patient themselves and can be due to their personality type. We must also consider how a patient’s previous unfavourable experiences with medical colleagues could blur their perception of you. 

Furthermore, some patients have such a strong personality, that they are unable to let go of the control and accept your advice. Some patients may come across as the opposite, unable to make a decision and asking you as the dental care professional to help them decide, attempting to pass all that responsibility on to you, or the clinician. 

System factors

As members of the dental team, we are all aware how noisy the dental practice can be; autoclaves whistling, doors slamming and receptionists on the telephone can make it a less than ideal environment for a difficult conversation! Any distraction will lead to ineffective communication. Have you ever tried to have a difficult conversation while there are other conversations taking place around you? It is impossible. 

Difficult discussions and conversations with patients do not only reflect good patient care, but they also form an essential part of the consent process and should be accurately documented. Sadly, Dental Protection have heard from dental care professionals who have been scrutinised by their employer/practice principals for taking up too much time talking and having conversations. 

Dental team

As dental care professionals, we know the benefits a good dental practice team can bring, not only to patient care, but to our own wellbeing. It also allows the work we do to run smoothly. Conversely, working in a poorly functioning or toxic environment is destined to negatively impact our mindset and in turn, our ability to communicate.

Personal factors

However hard we all try, at times it can be impossible to separate our private and professional lives. From time to time, the boundaries become blurred, and we lose focus. When we are dealing with personal stress, difficult conversations with patients can be extremely challenging. Inevitably, stress will impact the way in which we all communicate, in turn exposing dental care professionals to more patient complaints. It could be the slightest stress factor, such as a terrible journey to work or a disagreement with a relative that can negatively impact our communication style, not only with patients but our colleagues too. 

Difficult conversations can happen by chance or they may be planned, such as a scheduled appointment with a patient. These are what we would consider planned and unplanned difficult interactions. 

Planned difficult interactions

Planned interactions are always preferable, as you know they are going to happen and have time to prepare. For example, a patient who is attending for treatment that is likely to result in an extraction. Another good example is having to tell a colleague that a patient has called to make a complaint relating to care they provided. Both are challenging discussions to have, so we would plan if possible.

The words we use in a planned difficult conversation can be vital for a successful outcome. For instance, the words you use when informing a patient of the poor prognosis of their tooth. We can and should choose our words wisely. There are some aspects of the planned conversation that you should consider, even those that may not seem obvious at first. For example – the setting. Do you want to have a potentially heated conversation in the waiting room in front of all the other patients? 

Both dental care professionals and patients alike would prefer a private and comfortable space for a potentially difficult conversation. This space is best served as a non-clinical environment, to prevent any heightened anxiety for the patient and result in a better outcome. 

A critical component to consider is who will be present during the difficult conversation. When with a patient it is best to be chaperoned, preferably with a composed member of the dental team, who will support and not distract you. But what if the difficult conversation is with a colleague? It’s important to keep out of earshot of other staff members by locating an appropriate setting away from the practice. This can prevent any unwelcome complications of gossip and rumour mongering. This would be an unfair and disappointing development and, ultimately, would not achieve the desired outcome of your meeting. 

As you may agree, difficult conversations can be awkward and stressful. Feelings of stress can affect the way in which we absorb and react to information put forward to us. Therefore, we should choose to ‘respond’ rather than ‘react’. When we become stressed, a switch is flipped in our central nervous system, resulting in a ‘fight or flight’ reaction. While we can successfully converse in the ‘fight or flight’ response, it’s much easier when we remain cool, calm and collected. Choosing to ‘respond’ and sidelining the ‘fight or flight’ reaction will inevitably result in a more amicable outcome. 

Unplanned difficult interactions

When an unplanned difficult interaction occurs, we lose control of some of the elements of a ‘planned difficult interaction’. It’s vitally important that we do not lose control of ourselves and remain composed. The temptation to react should be kept in line as far as possible, to ensure we do not act in a way we would regret. It may seem trivial, but even taking deep breaths can help you to remain calm and keep a clear mind.  

Whoever may be in earshot of a difficult unplanned interaction will be judging you, your professionalism, and ultimately the way that you deal with this situation. We must also remember that in the current climate, there is always the chance you are being filmed on someone’s mobile phone. Regardless of the obvious breaches of the Data Protection Act, we all know that the video could be in the public domain in moments, and once it’s out there, it’s almost impossible to successfully retrieve it – something that none of us would want or hope for. 

Consequences of difficult interactions

The professional consequence of a difficult interaction can be a complaint, and while many of these complaints will be made at local practice level, some will be escalated to the GDC and/or NHS England/Wales/Scotland. Principle 9 of the GDC Standards is the overarching framework that clearly sets out how we as dental care professionals are expected to conduct ourselves. The GDC would take a dim view of those who do not behave in a way that maintains a patient’s confidence in the dental profession.  

Naturally, a difficult interaction can make us feel generally uneasy, and when it doesn’t go well, can make us feel really unhappy – unhappy about ourselves, the situation and the outcome for the patient. Nevertheless, the consequence of these difficult interactions can have a cumulative effect and impede our ability to have healthy interactions with patients and colleagues, eventually seeping into our personal lives. 

In all, it’s far better to try to pre-empt difficult conversations in difficult situations, and manage them and ourselves as best we can. 


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