Difficult patient

We’ve all had them in our chair. The patient that loudly exclaims how much they hate the dentist as they are being seated. Some will even move beyond that declaration and become downright difficult to treat-refusing to lay back or comply with treatment recommendations. But the worst are the patients that are angry and combative. Before we escort any of these patients out the door, here are a few tips for turning the appointment around before it gets out of hand.

It’s them, not you

Stay calm, easy to say and harder to accomplish.  Most patients aren’t actually lashing out at you, the provider, but at the situation they perceive in their heads. Studies show that 36% of patients have a fear of the dentist. Some of the fear is founded in past experience, and some of it is perceived in stories they’ve heard or imagined.  It could be anything from perceived pain to fear of how much it’s going to cost!

Get Curious

The only way to get to the bottom of that angst is to listen.  Recognizing and addressing the behavior directly will help you bring to “the why” of the difficulty. 

Try something like, “I can tell you are upset. Let’s figure out how to make this work so you can get the care that you need.  What exactly do you need right now?”  While you might not be able to deliver on all the requests, this establishes a space where the patient can reflect on their behavior and their needs.

Connect with the Patient

When patients feel connected to their provider, they feel safer—taking time to understand them as individuals is key to providing that safe space.  Keep notes about personal things you learn to jog your memory at each appointment.  But beyond the personal stuff, one of my favorite questions to ask difficult patients at the beginning of our relationship is, “Tell me what you like and don’t like about dental visits.”  This question is a great way to figure out the patient’s triggers. Many things they don’t like are modifiable.

Set boundaries

You do not have to accept all behavior in the name of fear (or for the almighty Google review).  If a patient is being combative or inappropriate, identify and address it calmly.  If you need to bring in another team member for safety or clarification, do so.   Be sure that patients understand they are not being ganged up on but that you want to ensure everyone is understood.

Say something like, “We are clearly having trouble communicating. I’m going to bring in Sally to help us both with perspective.”

Bye Bye Bye

Some patients have to go.  While no one likes to lose a patient, it might be necessary for the good of the team and the safety of the practice.  Be sure to review the laws on dismissing a patient properly so you are covered legally. It usually requires written documentation and providing emergency care for a certain period of time. 

Hopefully, it doesn’t need to come to that.  When we think of our difficult patients, instead of focusing on their challenges, think of their objections as asking for assistance in understanding.  Take a deep breath and remind them that you have the same goal: to care for them.

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