By Denesha Prescott a third year dental student at the University of the West Indies, Mona Campus.  

Many individuals’ first exposure to a becoming a dentist is through the media. Dentists are seldom portrayed in a positive light on TV shows and in movies, often being the cause of the antagonists’ villain origin story, or as the source of pain and suffering for some unsuspecting adult or child. According to Ann MacDonald in a 2010 issue of Harvard Health Blog, 13 - 24% of people around the world, dread visiting the dentist.  It is our responsibility as dental professionals to help ease this fear and anxiety when patients do show up. It is easy to dismiss a patient as being difficult when dental appointments don’t go the way we expect them to. A ‘difficult patient’ can be defined as a patient who is troublesome, tedious, or non-compliant with instructions given. Difficult patients create difficult situations which can often transfer into how we perform our duties as professionals. A patient can be difficult for many reasons. These reasons include, but are not limited to, having a dental fear or phobia, being in pain or unwell, having a previous bad experience, language barriers, stress and fear due to the pandemic, and even the dentist’s gender, age, and level of experience. Some patients may just be very demanding and picky about the type of dental treatment offered, and may never be satisfied, no matter what the outcome. It is important to therefore “meet the mind of your patient before meeting their mouth” - De Van. Once you figure out why your patient is expressing certain types of emotions, then you may decide whether to pursue the desired course of treatment.

Slow down and listen to your patient

The first thing that every student dentist should learn, is how to slow down and listen to their patient’s concerns. If you have ever been in a clinical setting, you know how fast paced everything is. Most of us are rushing to set up our chairs, getting instruments from the sterilisation room, or quickly going over our patient’s files before the initial presentation of the case to the floor – so much so that we often carry this rushed behaviour into our patient interactions.

Most human beings like to feel as though they matter and are more than just duties to fulfil.

They want to know that their best interest is the focus. It is relatively easy to identify a patient whose intention it is to be ‘difficult’ within the first visit. It is important to find out what the patient’s expectations of this dental visit are and make a written note of it in the patient file.

According to Dr Bhumija Gupta DDS, talking to a patient at length is an investment. The first visit is therefore an ideal opportunity to figure out the patient’s personality and determine whether you are the right fit for that patient. Patients also notice when they are being rushed and this may send a bad message to them that their concerns are not important enough to be heard. This leads to them becoming irritated, not wanting to comply with any pre or post treatment instructions, or even refusing to pay for the treatment they’ve received. Listening to your patient will help you avoid many misunderstandings, loss of finances, and even potential lawsuits.

Clearly communicate with your patient

Clear communication between all involved parties is very important in the dental setting, as it helps to minimise possible misunderstandings. The cost of a procedure, how long it should take, how it may look, possible complications and everything about the procedure, should be explained to the patient in layman’s terms prior to beginning treatment. Have the patient then relay to you what they understood from your explanation.

Once a patient understands what is about to take place, it may help to ease the fear and anxiety associated with visiting the dentist. When interacting with a patient, it is also important to note at each appointment what their expectations and concerns about the proposed treatment are. Some patients are concerned about their aesthetics, some are only concerned with alleviating their pain, and others are more concerned with restoring functionality. You as a dental professional are tasked with deciding if what the patient is requesting is achievable or not. Provide a clear explanation of what is and is not achievable and assure the patient that you will do your best to deliver the achievable goal. Do not merely assume that the patient understands without having them reflect on the conversation in their own words what they expect the outcome to be.

With each conversation between yourself and the patient, keep a clear and legible record in the patient’s treatment log. This record may come in handy should the patient backtrack on the conversation and try to report you to the dental board or bring a lawsuit against you or your office.

It is ok to say ‘no’

Despite your best efforts to meet the needs and expectations of your patients, some patients may just never be satisfied. A colleague of mine had a patient try to dictate how a composite restoration should be done, having never set foot in a dental school as a student before. This created a stressful environment for the dental student, as nothing the student did from then on was good enough.

I have encountered a few patients who were adamant about what should be done, even though the treatment plan said otherwise. Sometimes it is just best to part ways with a patient with unrealistic expectations or who are difficult to please.

I once had a patient complain to me for almost ten minutes on the phone about why they will never return to the clinic. After a few days had passed, that same patient called requesting to book an appointment because they knew we were students and they wanted to ‘help out’.

Establishing professional boundaries is an important part of this profession, because at the end of the day, we are human beings with emotions. It is within our rights to reject patients who may, over time, cause us unnecessary distress before, during or after treatment.

The way in which you go about parting ways with the patient, however, should be done respectfully and without animosity. As previously mentioned, the reasoning behind parting ways with the patient should be stated in detail in the patient notes.

The importance of dental indemnity

Indemnity can be defined as security or protection against a loss or financial burden. Should a patient become so upset that they retaliate through a legal team, or by reporting you to the Dental Board, this is where dental indemnity comes in.

Dental indemnity is a necessity as a dental professional, it helps to provide you with legal advice and support should complaints or lawsuits be filed against you by a disgruntled patient, as well as helping to protect your assets if a claim for compensation is filed. In a time where money can be

hard to come by, it is imperative that you sign up for dental indemnity to protect yourself and your future income.

Diffusing difficult situations

When difficult situations arise, you should stay calm, relax your facial expression, check your body language, and use positive softly spoken sentences to engage the patient and diffuse the situation. Maintaining eye contact and keeping an appropriate space between yourself and the patient, while reassuring them without cutting into their conversation, is a must. Asking open ended questions and listening to the patient fully can help you to find out what the main issue is. Acknowledging the patient’s concerns, treating the patient with respect, and exploring solutions with the patient can help to minimise difficult situations.

Citations:

MacDonald.A. (2010) Dental fear? Our readers suggest coping techniques. Harvard Health Blog. Cited from: https://www.health.harvard.edu/blog/dental-fear-our-readers-suggest-coping-techniques-20100825327

Meyer.E. (2012) Meeting the needs of difficult dental patients. Clear communication and careful preparation can help moderate stressful situations. Inside Dental Assisting. Volume 10, Issue 5. Cited from: https://www.aegisdentalnetwork.com/ida/2012/10/meeting-needs-difficult-dental-patients

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