Dentists’ Feedback to the communication scenario published on April 2nd

On April 2, we posted a scenario about communication with patients and its role in the success of the dental practice. We then requested your feedback on how you would handle this situation.

We are pleased to present a summary of the responses that we received. 

Read the feedback in PDF

 

 

Summary of Feedback

Mutual respect is a cornerstone of relationships and especially so with Doctor/Patient interaction.

1. Request/agree to meet face-to-face with the patient (female?) and allow/suggest the patient to have someone accompany them should they wish that. Have a person from your staff present (female) who preferably has not had a confrontation with the patient present.
2. Prior to meeting you should have reviewed all matters pertaining to the patient’s records and all contacts with your practice.
3. Explain to the patient that they can submit their complaints in writing, orally, or both and that your main goal is to resolve their concerns.
4. In the event that they accept the opportunity to vent their complaints let them know that you will provide them with a copy of your record of the meeting. You should let them know that you are willing to have an independent third party, agreeable to them, adjudicate any differences that might exist if they do not accept the outcome of the meeting.
5. Should the patient refuse to meet under any circumstances (ensure that they receive the offer in writing), you may have reached an impasse and respectfully indicate to them, again in writing, that the doctor/patient relationship has broken down and that they should seek another dentist. You will also indicate that you are willing to complete essential, unfinished treatment, or emergency treatment in the interim period which should be defined.
6. Report the matter to your malpractice insurer and your licensing body.
7. Ensure that all records are current and legible.
8. Obtain advice from both or an independent legal advisor regarding your actions.

If an operatory or consult room is free, have the patient seated in this room so that the treating Dentist and the disgruntled patient may have some dialogue. Try and get to the root of the issue. If it is treatment that they are not happy with find out discrepancy between expectations and results and how this may be resolved. If it is an issue of pain resulting or not resolved from recent treatment performed at the office find out what the issue is and if it can be resolved at the office. The Dentist must show empathy. If the patient is not receptive to this, offer to have their record transferred to the Dentist of their choosing.

I would tell patient that unfortunately she seems to have lost confidence in me as a dentist, my staff and my dental office so she would have to find another dentist to treat her. She would be dismissed from the practice… I would see her on an emergency basis until she finds another dentist and forward all the records to her new dentist

1. Match his voice pitch and volume just for a split second; and immediately start speaking softly. He will follow you to the lesser volume and pitch!
2. Ask him inside to a private room for a discussion.
3. Always make him feel that he is being heard by acknowledging and repeating his concerns.
4. Ask how he would like to have the situation corrected.
5. BY and large I do what he wants if at all possible incl. money back if reasonable amount because the other side of the mountain is not ever a happy place for a dentist. Even if the dentist wins, he will lose much more financially and emotionally.

I have had this occur 3 times over many years. In all cases they were patients that were under psychiatric management. In one case I was able to get the patients councilor to manage the patient. In two cases I have had to call police to remove patients and take them to hospital. Other patients in office seemed to understand and there were no other repercussions.

It is clear that there is something wrong and that this patient needs to be heard. I or my office manager would ask the patient to step into our consultation room and then after asking what is going on, or what has happened to upset him or her we would listen to what the concerns were. We would then see how we could meet the needs of the patient or resolve the concern. Any time this has happened, just listening to the patient goes a long way to resolving miscommunication or something we have missed or not communicated. Documenting this event is important as well. If the problem/concern is something we can resolve we will do our best to resolve it. If we are unable to resolve it we would let the patient know and look for an alternate plan that would satisfy the patient- this may include referring the patient. Usually the front desk staff or I will sense dissatisfaction at an earlier stage so discussion and resolution will occur before it reaches a confrontation stage.

I don’t think there is enough information to offer opinion.  What the complaint about treatment, fees, personalities, staff, quality of treatment, etc.. Medical issues, great to have another view other than the DDS to say everything was ethical, following a treatment plan, etc.

Tell her our values on a working professional agreement do not coincide and she needs to find another dental office now.  She should let us know where to forward her file, and she is covered for emergencies, i.e., pain, swelling, or bleeding, for 30 days. Call the Police, if necessary.

Call security

Contact PLP for guidance on dismissing this patient.

Have the patient come in to your private office ALONG WITH YOUR RECEPTIONIST and ask what the real problem is.  In a similar situation I found out, as the patient broke down, that she was given a diagnosis of liver cancer a few weeks before and was having increasing difficulty coping with the reality.  If the patient really has a problem with your treatment, offer to refer him or her for a second opinion.  Make sure you contact your malpractice insurer because a lawsuit may be coming.  Don’t worry about that.  That’s what we have insurance for.

If the patient has decided to resort to this kind of behavior there is no way you can handle it.

You could attempt to get them in your private office but it will be a waste of your time and gut lining. They are looking for you to take responsibility to pay someone else to do it. If you have done all this informed consent and they have signed off you can only do one thing – Call the Police

 

Once you have asked the patient to leave the premises, you are faced with the decision whether to call the police or try to diffuse the situation yourself. If you feel you or your staff are in danger then the decision is simple, call the police. These situations are not generic. It depends on the nature of the complaint and the temperament of the complainer. If the patient cannot be satisfied it may in everyone’s best interest to ask the patient to make other arrangements for his or her dental care.

The KEY word in this given scenario is “increasing” difficulty….

In 30 yrs. of private practice, I never had to deal with a situation as described (I am touch wood now!!).  That is not to say that I never had a “difficult” pt.  I just learned to catch their dissatisfaction in time – as it was “increasing”, and took immediate steps to resolve the problem(s). A little bit of private chat and explanation would go a long way in resolving misunderstandings and unreasonable expectations. In all 30 yrs., I did have to refer a pt. out, to get “expert opinions” on a treatment outcome.  The pt. was satisfied after seeing the specialists (two of them), and is still in my practice to this very day!

Conclusion: The BEST way to DEAL with this situation is to PREVENT it from developing to this stage in the first place.

Good luck with the discussion; I’d like to learn how to “DEAL” with it too!

I would invite the patient into my private office, ask an employee to be present…review the specific reason(s) of dissatisfaction, in conjunction with my treatment notes.  If in my opinion I have done nothing wrong/unethical, I would ask the patient to register a complaint with the licensing body (In Quebec the Order of Dentists) for their assistance in resolving this situation. If it is a thoroughly unreasonable patient and the amount of their dissatisfaction is $500.- or less, I would offer the patient a full refund if that would make them happy…otherwise go to the licensing authorities and see what results.

Call the police and have her charged with trespassing.

I would arrange to meet with the patient privately and sit down and discuss the concerns with our office. If there are problems with treatment I would volunteer to deal with that issue at no charge or possibly refund the cost. If the problem relates to the front desk personnel I would verify that the concern is legitimate and make the appropriate apologies with an assurance that the situation would not recur. If the problem is entirely with the patient and all attempts to resolve are unsuccessful I would volunteer to find a new dental home for the patient.

 

At all times I would expect my reception staff to remain calm and to try and resolve the problem by moving the patient to a quiet room away from the waiting room.  In our health facility we have a consult or a spare operatory where we would invite the patient to address their problems. If the staff cannot resolve the problem, they would definitely ask the dentist to step in and diffuse the situation.  Stepping back, if you practice with a philosophy that includes knowing your patient you should be able to identify their personality and resolve any issue.

I would ask the person nicely to calm down, come into my office to discuss this further and suggest that I would try my best to help by explaining what he/she is misunderstanding.  And pray for a decent resolved outcome

You’ve given very little info to work with,but if the person is abusive I would call the police. If you do land in court the police report will at least demonstrate the behavior that person is capable of.

I would “fire” the patient, with a nicely and appropriately worded letter. Obviously, I am not providing what she needs/wants.

Request the patient to join you to a room at the back (office or consult room) and discuss the matter. Try and resolve things in a calm manner.

I would ask the patient to the consultation area or an operatory, to discuss the problem, anything to get the patient out of the reception. If the patient is not happy, I would suggest that the patient find an office that is more in line with the patient’s expectations, and re assure the patient that we would treat any emergency needs until they find a new office. If the patient does not go voluntarily, after two months, send a letter that the patient doctor relationship has failed and dismiss the patient, but again treat emergency issues only after a given date.

I would bring them into my office and explain that we are too far away in what I can provide for then and what they can expect. I would provide two names for referral and if the problem continued I would please ask them to leave short of this I would not tolerate any abuse and call the police to escort them out.

Invite the patient into a private room to discuss. Ensure one of your staff is present to witness.

First have the receptionist tell the patient that she would see if the Doctor had time to address the patients situation ask the patient to have a seat then go to the back and talk to the doctor. If the doctor has time he can see the patient in his private office with a cda present. If not tell the receptionist that the Doctor would like to set up an app. to address the issue.

I would try to get this patient into a consult room or a private office as quickly as possible so that I could have a private chat. If I was in the middle of a procedure I would want the front desk staff to let me know that there was an “emergency” happening in the reception area and they would have to escort the patient to a place where I could talk with them quietly(as above). Then, summoning up my courage I would have to meet the patient face to face (with a staff member accompanying me) and just listen to them. Hopefully this would help de-escalate the situation enough so that the patient was speaking calmly and rationally. Most people just want to be heard, however, if it looked like this approach was not working I would have a signal to alert the staff so that they could call building security or the police. The safety of the staff and the other patients in the office (and lastly my own) would take precedence over everything. After all the dust has settled from this crisis I would seek legal advice and dismiss the patient, in accordance with all the guidelines of my regulatory authority. I would not give this patient a second chance to cause such a scene in my office and I could not possibly continue to treat someone who has no respect for me or my staff or the other patients. In this scenario I am assuming that the patient is not armed and does not have a history of violence in the community. If that was the case I would call the police right away and have the person escorted off the premises immediately.

1. Remain polite and professional.
2. Have the staff (especially a mature person the patient is familiar with) tactfully handle the issue and attempt to redirect the patient to a more private place.
3. Many times patients need to be heard. Once a calmer atmosphere has been established the staff member should listen to and record the patient’s concerns and ensure they are addressed within a couple of days.
4. Having the dentist involved may be counterproductive initially.
5. Ensure the patient’s needs are met, either within this office or another.
6. Seek a resolution within 2-3 days.
7. Maintain civility, professionalism, and a sense of humor without insulting the patient.

 

Listen, you cannot please everybody. Even in the best hands things will fail. Politely tell this patient that you did your best but it is time to find another dental provider. You will transfer all appropriate records once the transfer letter is received. Also, make sure you dismiss the patient from the practice in writing in 60 days and no further treatment will be rendered.

The last time I had someone like this I was just lucky. I had popped out a wisdom tooth in less than 60 seconds on a super Bad 22 year female.  She was back the next day 45 minutes before I got there with boy friend swearing at us because “it hurts so much.” It was super simple removal but I had noted the previous day I would never work on her again because she was so bad.  So after they swore at me for a few minutes – I think I just said “I am not a psychiatrist- you can see one / I am busy -get out now.” I was lucky-they did.  There is no great answer- there are some really bad people out there.   I can also remember a similar 58 year old male who bitched that I did not talk to him enough for his occlusal filling on 14 that took me 5 min and was painless.  It was not enough.  We needed to sit around the campfire and bond.

I would give them their money back and refer stating that it would be best for both parties due to a personality conflict.

1. Less headaches and stress
2. Not have to deal with complaints committee. Even if you’re right you will spend countless hours/days with letter writing and interviews.
3. Consider it the cost of business

There is very little that you can do to calm a hysterical patient other than politely listen, agree with their feelings and offer to sit and talk in a quieter setting in the office. Emotions about any failure in the patient’s perceived outcome of treatment (cost, timing, success, pain, etc)  can only be acknowledged by the team. Once venting is over, any problems can be dealt with in a professional manner.

A much better method of the management of the patient’s emotions over treatment is to address potential problems prior to any treatment being performed. Expectations of the patient, costs, timing and potential pitfalls can be discussed in a non-operatory setting prior to booking for the treatment. Then the patient has a realistic expectation and informed consent about the treatment. Knowing that a replacement restoration may require a root canal up front can allow the patient to accept ownership of their situation and avoid outbursts. Financial agreements about cost, signed consent forms covering potential risks, and conversations prior to and after treatment about the potential issues with the treatment also prevent unexpected outcomes from creating an emotional patient As well, every dentist should take the time to continually train and educate the team he works with about procedures and policies in the office so that a standard of care with patients is consistent and positive. Team members who do not live up to the expectations of the office can then be helped to provide better patient care consistently.

We are in a service industry. We serve our patients. Anyone on the team who is not willing to express genuine care and empathy for the patients they treat must either learn proper protocols or move to another industry. It is the patient that pays the salaries and the patient’s perception of the dental office is key to continuing success.

Listening is the first step to settling the patient down.  Agree and acknowledge any legitimate concerns.  Ask the patient how I may rectify the problem.  Try to find a solution that satisfies both parties.  If the problem is lack of trust in my services, then I would offer to transfer his/her records to a dentist in whom they trust.  I would offer a refund which allows the patient to gain the treatment again with someone else at no cost to him or her.I would try to move the patient into a private consultation area to fully discuss and understand the concerns.

People can be really difficult and there are no negative consequences for them. I have called police in the past.  They hate responding and sometimes won’t. I practice in a socioeconomic depressed area.  Yesterday my receptionist tried to help a stupid 72 old figure out if she had coverage before we saw her.  In the end she asks the lady to go home and get her coverage information sorted out so as to not incur unwanted costs.  Her daughter showed up later to scream at us and complain on social media for our “terrible treatment” of her mother.  My receptionist spent 30 minutes with her stupid mother who knew nothing of her coverage and could not make a decision to proceed with exam etc. and pay it herself.  In the past I have had one confirmed drug dealer smash my door to pieces and be arrested on the sidewalk.  It resulted in his outright release as only property was damaged and not worth court time.  I was advised to just make insurance claim and live with it.  We had refused doper drugs.

Well the first thing is to get them into one of the Operatories…if there is a vacant one or into the Patient Presentation room if there is one. Then the person whom the upset patient has the “beef” with must sit with that patient for at least an hour or more to get consensus on the details of the issue. Ask them how they would like to you to rectify or settle the situation. From there it is usually a question of money.

Mr. Patient I see something is bothering you.  I would love to give you our undivided attention.  When is a good time we can discuss this together?  I know your time is important and something is bothering you.  My office manager will write down your concerns, in private and I will review your case.  Office manager schedules an appropriate time. If the patient continues to talk I would say.”

I cannot talk about your situation because of the privacy laws.  We need a quiet time!

In 50 years of practice I have found this to work.

1. Reassure the patient that you will listen to their concerns today but because of their privacy I invite them into a closed room, take the time to let them talk (cancelling patients if necessary) and ask them specifically what would make them happy.
2. Far better to have someone making a fuss in your office in front of patients who know that you are OK than dismissing the concerned individual who is then free to talk negatively about you outside your office.
3. Rather than adopting a confrontational position asking people what they want often yields a surprisingly simple solution which can keep everyone happy.

I would ask the patient “I understand you are upset and have a right to be upset I would be upset to! Please come with me and we will discuss how to resolve this matter taking the patient to a private room. Then I would suggest full refund and explain I will send all X-rays and charting to dentist of her choice immediately if that is what is needed to resolve the situation. If the patient wants to stay I would go over the problems associated with the current treatment.

I would ask the patient to come to a consultation room to talk to him or her. If there is not enough time for this I would still try to get her to go into a consultation room and schedule an appointment for a discussion at a later time.

I would begin by inviting the patient into a ‘quiet’ location, such as my personal office. I would then issue an apology AND a statement: “I’m truly sorry that our clinic did not meet your expectations. I will offer you a number you can call if you wish to pursue further grievances regarding your treatment here (provincial association complaints liaison). We will be happy to cooperate with a new dental clinic of your choosing by forwarding records of treatment and radiographs”

If all fails, send a polite dismissal letter with availability for 30 days for any emergency care.Try and calm patient down and tell them you will call them the day after as an upset patient will not be open to reason. Call and try to find out what the patient is really upset about. Sometimes error in billing can cause an irate patient. The fact that the patient comes back to get work done shows that the trust is there.

Dealing with difficult patients is de rigeur for dentists dealing with the public.

Main thing is to always remain professional and calm. If front office staff cannot handle the situation, then the dentist must intervene. I would kindly ask the patient to come with me to my private office to discuss his/her grievances; but I would leave the door open and make sure my assistant or front office staff person is also present. Hopefully with time, the issue can be resolved calmly. If not, then I would have to seek outside assistance. Where I work, I call for mall security to come assist. Otherwise, if absolutely necessary, assuming the individual is loud and disruptive, the police would need to be called.Dealing with difficult patients is de rigeur for dentists dealing with the public.

I am a caregiver so I am mentally feat.

By ignorance or prejudice the patient try to abuse, scorn and vilify me and I don’t know if he is mentally challenged or not.

I would keep composure and tell him that the persons from waiting room will resolve and take him at his word and this will be a devastating lurid outcome for me.

For most of as once the surge of bravado subside the depression make room for negotiation