Dealing with difficult patients

Article featured in Dentistry, March 2021

Communication is key in dentistry, particularly when it comes to dealing with difficult patients, Claire Wigley says.

Dealing with aggression and challenging behaviour in the workplace is very stressful and can affect the whole team.

Under the current circumstances, tensions are understandably a little more fraught than usual; we’ve all felt the stresses and strains that the pandemic has brought. Whether it’s due to worries around the spread of the virus itself, or personal circumstances such as finances or grief.

This means that your team may experience a higher level of aggression from patients.

It’s also worth considering that your staff members themselves may suffer with high-stress levels. So management of challenging patients may prove trickier than usual.

With this in mind, it is essential for the team to know how to respond to these types of situations and what to do to minimise the risk to themselves and other patients.

All practices should have appropriate policies and training in place. It is worth considering refresher courses in light of the pandemic to help prevent situations escalating.

Types of difficulty

Problematic situations with patients in your practice can present from a range of feelings and emotions, which may be heightened in the moment.

There are various ways that a patient can be difficult, or appear difficult; some of these could be a result of personality traits:

• The grumbler – some people just love to moan! This is a personality trait. Having the ability to recognise this will allow your team to know whether they are dealing with a grumble or an actual complaint
• Generally difficult – these patients may try to drag you into a verbal argument by pulling on your own emotions. This is especially relevant at the moment where tensions and anxieties are understandably high
• Dissatisfaction – this can occur for numerous reasons. But one of the biggest factors at the moment is not knowing what to expect when they arrive for their appointment. Such as waiting outside, attending alone, temperature checks, wearing a face covering, social distancing, etc. Your practice can manage this fairly easily by ensuring all patients are well informed prior to their appointment
• Manipulative – a patient may try to convince you to speak to the dentist to get a prescription. Or persuade you to give them special treatment and will become argumentative if you don’t give in to their demands. You can manage this well with good listening and communication skills
• Aggressive – a patient may shout at or berate staff members, and on occasion, it may get more physical than this such as throwing things or spitting. On the whole, people don’t go from zero to one hundred in the blink of an eye. So you can prevent this level of aggression by listening to the patient and easing the situation sooner. However, the practice must have a zero-tolerance policy towards this kind of abuse.

Reasons for difficult behaviour

There are many reasons why difficult behaviour could occur in a dental practice.

The most common reasons are being frightened or nervous, being in pain or unwell, or having had a previous bad experience.

Language barriers can also become a problem. And, in some cases, alcohol or substance misuse could be the underlying reason.

More recently, stress and fear as a result of the pandemic can be another factor causing upset that manifests itself as difficult behaviour. This is often as a result of a change in the way the service is carried out.

It is important to communicate your new protocols to patients before they attend their appointments. This helps the smooth running of your business and allows them to adjust better to what is required of them, rather than leaving them feeling caught off guard.

It might sound like a small thing, but it could just be the tipping point of their day.

It is important that whoever is dealing with a challenging patient has the right approach to resolve the situation quickly and efficiently.

This requires clear and effective communication within the team to ensure everybody is aware of procedures and has sufficient training on dealing with difficult patients and complaints handling.

Take a step back

Different reasons for patient upset require different approaches to diffuse the problem. For example, if the anger stems from them feeling frightened, then they may simply need a sympathetic ear, a glass of water and calm space to feel safe in.

However, if a patient is truly angry and has a genuine complaint, it is essential for the team member to take a step back and think about the problem and the situation.

Very often, a patient who has their issue dealt with efficiently and in a timely manner can become one of the practices biggest champions.

Top tips for diffusing a difficult situation

• Stay calm
• Think about your language and use positive sentences such as ‘An option to resolve this is…’ instead of ‘You fail to see that…’
• Check your body language
• Give the patient eye contact but do not stare
• Relax your facial expression
• Keep appropriate space between you and the patient
• Speak softly and keep an open mind
• Remain neutral
• Listen to the patient fully without cutting into their conversation
• Ask open-ended questions
• Reassure the patient that you are listening and acknowledge what they are concerned about
• Treat the patient with respect
• Explore all options available to the patient.

Reporting

Document all complaints in your complaints folder and follow up according to your complaints procedure.

Sometimes these situations aren’t about formal complaints and, unfortunately, are a result of an aggressive patient. If a situation like this occurs in a dental practice, then follow the practice protocol.

If the police are called, then the practice must ensure that not only do they complete an events form and enter this into the complaints log (if appropriate) that they must also report this to the Care Quality Commission (CQC) on the appropriate notification form.

The effect on the practice

The key to resolving these situations is communication and being open, honest, empathetic and asking intelligent questions. The right level of training can help all members of staff to deal with such circumstances should they arise.

Incidents with challenging patients can bring staff morale down in practice.

It is vital to remember this and ensure that a team meeting is called following the situation to ensure that it does not impact on the atmosphere within your practice.

Listen to the concerns of your staff. Try to find positives and learning points from it. It’s important for staff not to take these situations personally and for them to feel supported within their role.

How we can help

Here at Agilio we can help you with online learning for the whole dental team, with our iLearn CPD.

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