Crucial Conversations and Conflict Resolution

At some point in your dental career— likely more than once — you will be faced with conflict. In 2021 alone, The Dentists Insurance Company’s Risk Management Advice Line received 13,029 calls from dentists seeking support to navigate practice challenges. It’s a number that illustrates the myriad conflicts dentists navigate today as well as the profound need for tools to help them expertly de-escalate potential crises.

This is particularly true when the encounter is with an angry patient. When a patient’s anger escalates, a practice owner has a responsibility to protect staff from aggressive, belligerent and threatening behavior.

TDIC Risk Management analysts observe recurring patterns in the calls they receive from dentists seeking help with irate patients. Typically, these incidents stem from patients who are upset over: n unplanned expenses n treatment plans they consider unnecessary n failure to achieve expected results from cosmetic procedures n a dentist’s refusal to practice outside the standard of care when a patient attempts to dictate treatment

Senior Risk Management Analyst Taiba Solaiman observes, “Anxious patients often present as irritable and uncooperative.” Heightened emotions of anxiety or fear can produce behavioral responses that appear much like anger when the anxious patient is under stress.

It’s one thing for a patient to become angry. But when that anger manifests into threatening behavior such as yelling, cursing, stalking or violence, practice owners must intervene. As employers, they are obligated to provide a safe working environment for their staff, one in which employees are not fearful for their own safety.

A Case Study on an Angry Parent

In one case reported to the Advice Line, a woman brought her 8-yearold son in for an exam. The dentist recommended placing sealants on the child’s molar teeth. The mother was unsure about the sealant placement and declined the treatment. The following day, she called the office stating she had changed her mind and wanted to move forward with the sealant application after all. She brought her son in a few days later for the dentist to place the sealants.

TDIC Risk Management analysts observe recurring patterns in the calls they receive from dentists seeking help with irate patients.

A week later, the mother called the office and expressed that she wanted the sealants removed as she had done some research online and was concerned about the risk they posed. The dentist declined her request because he was confident in the treatment provided and, in his professional opinion, removing the sealants would be unnecessary and

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created the potential for causing further problems.

Over the next couple of weeks, the mother called the office repeatedly and harassed staff members. Ultimately, she showed up unannounced to the office with the child, acted belligerently and insisted the dentist remove the sealants or provide a refund to allow her to go to another dentist to have them removed. The dentist happened to be out of the office that day. She screamed and cursed at the office manager and assistant, creating an extremely uncomfortable scene for the entire team, including other patients in the office. Upon his return to the office, the dentist decided to offer the patient’s mother a refund and dismissed the patient from his practice.

A Case Study on a Demanding Patient

In another case, a patient demanded a refund for orthodontic treatment that had been performed several years prior. She said she had recently been to a different orthodontist who said he would be able to provide a better result.

The dentist invited the patient to meet face-to-face to assess her current clinical status. After performing a visual exam, he did not agree that retreatment was necessary, as his clinical findings simply revealed mild orthodontic relapse. The patient did not contact the dentist again until several months had passed and now stated that she disagreed with his previous assessment and insisted that he refund all the money she paid for the orthodontic treatment. The dentist refused the patient’s request for a refund because he felt confident that the case did not require retreatment. It’s one thing for a patient to become angry. But when that anger manifests into threatening behavior such as yelling, cursing, stalking or violence, practice owners must intervene.

The patient continued to repeatedly call the office demanding her money back. On several occasions, she showed up to the office at the end of the day insisting that she speak with the dentist and stating that she wouldn’t leave without her refund. The patient only left the office when the dentist threatened to contact the police to have her escorted from the premises.

The patient eventually filed a complaint with the Better Business Bureau, which prompted the dentist to call the Risk Management Advice Line. The analyst advised the dentist to simply respond to the notification from the BBB by stating that he would reach out to address the matter directly with the person who filed the complaint. The patient’s final action against the dentist concluded with the filing of a negative online review.

Communication Strategies

While it is unpleasant to deal with angry patients, understanding some key communication strategies will help you to diffuse strong emotions and can generally lead to more positive outcomes.

Keep calm and

communicate. Taiba Solaiman points out that the best course of action to take when faced with an angry or irate patient is to remain calm.

Respond with a professional demeanor and let them know you are willing to hear them out. “Sometimes patients just want to be heard,” Solaiman said. “Sit down with them privately and let them know you understand they are upset and that you are willing to listen to their concerns. A compassionate ear can go a long way in diffusing a tense situation.”

With patients, clarity comes with listening to concerns firsthand, not deflecting issues or delegating them to staff. Patients, just like everyone else, want to feel heard. Allow them to voice their concerns without interrupting or speculating on what may be driving the issue. Listen attentively to the patient and then repeat back your understanding of their concern so there is no misunderstanding about the source of conflict.

Set boundaries. Showing compassion does not mean you shouldn’t set limits. Be forthright about what is and isn’t achievable or realistic. own decision. If handled correctly, offering patients their money back does not imply or equate to an admission of guilt or wrongdoing but rather a desire to bring the matter to a mutually agreed-upon resolution. “In many cases, offering a refund can be the best way to diffuse a situation and prevent it from escalating,” Solaiman said.

Don’t forget documentation.

Just as you make careful notes regarding treatment in a patient’s chart, you should document any conflicts that arise with a patient. One of the most important steps a practice owner can take is to document that the issue was discussed along with any steps taken to solve the problem. If staff members were present, their involvement should also be carefully noted in their employee files in the event there is a complaint to the U.S. Department of Labor for a hostile work environment.

Solaiman cautions that if these efforts fail and the patient continues to harass or threaten you or your staff, it’s probably a good idea to dismiss the patient from care, as a last resort. Patient dismissal, however, must be considered carefully, as the circumstances leading to dismissal may vary on a case-by-case basis. Carefully document all conversations with the patient that led to the decision, ensure the patient is not mid-treatment and follow a formal dismissal protocol. Risk Management analysts can provide advice regarding your specific situation as well as sample withdrawal letters.

Unhappy patients are an unfortunate reality of practice ownership. Handling conflict in a prompt and transparent manner is important, as it prevents the issue from potentially escalating or becoming a larger problem.

Let the patient know that you cannot allow them to dictate treatment, nor can you practice below the standard of care. Should a discussion become heated, it may be helpful to bring in a third person, such as an office manager or another staff member with whom the patient has a good rapport. Often, a third party can help explain the situation in a way the patient understands and is willing to hear.

Respond with a professional demeanor and let them know you are willing to hear them out.

Consider compromise. For instances in which patients demand refunds, each dentist must make their

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Opportunities to Calm Anxious Patients

Look for opportunities to make your dental practice a space that inspires calm and confidence.

Communication:

• Encourage all staff members to speak in relaxed, friendly tones with patients and one another. • Before treatment begins, agree on a nonverbal sign that the patient can make to signal the need for a break from treatment. • When interacting with patients, normalize anxious feelings and avoid negative phrasing. Instead of saying, “Don’t worry, this will only hurt for a second,” try saying, “I understand you are nervous.

Let’s take deep breaths together while I make a slight adjustment.” • Encourage patients to ask questions and keep them informed during each step of the procedure (unless they express a preference otherwise). Comfort: Allow patients to bring appropriate comfort objects with them, like a pillow or earphones. • Determine if the patient would benefit from a warm or weighted blanked placed over them during procedures. A weighted X-ray vest can be an alternative. • Make space for a supportive friend or family member to join an anxious patient (if possible, considering COVID-19 protocols). • Consider lobby and common-area lighting. Spaces with plenty of natural lighting tend to be more calming than those with harsher lighting. If lighting in the treatment area distresses an anxious patient, allow them to wear sunglasses. • When choosing office décor, cool tones like blue and green in soft shades evoke a sense of calm.

Water features provide soothing sounds that mask sounds of equipment that may trigger anxious patients.

Control:

• Help patients feel a sense of control by giving them options. For instance, prior to the procedure you could say, “Let me know when you are ready to begin,” rather than, “Open wide.” • When possible, allow patients to hold the saliva suction so they have control over when they need to expectorate. • Allow patients the option of using hand signals to let you know when they need breaks during treatment.

Distraction:

• Provide screens in treatment rooms. • Play calming, engaging music throughout the office. • Offer noise-cancelling headphones and a selection of music. • Coach anxious patients through breathing exercises. • Hang interesting art or posters on the walls of the office. • Provide patients of all ages with small hand-held objects that provide sensory distraction, like fidget spinners.

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