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Professional News Articles : : ON PRACTICE MANAGEMENT by Janyce Hamilton : Charming confrontational patients

Charming confrontational patients

July 22, 2010

The unloving patient. Need we say more? In the waiting room: “What’s the hold up? My time is worth something, too.” At checkout: “Did your prices go up? Because I paid under $100 for this at my last dentist.” In the chair: “Why now do I need a crown? You never said anything about that before.”

Many people avoid confrontations of this sort. A patient in a bad mood asks that terse question or makes a pointed comment and you wonder why you didn’t become a plumber or veterinarian.

But there are some who rather enjoy tackling this stuff: the professors of communications and doctors of psychology. Debating, defusing and even persuading are their verbal arts.

Flipping a foe into friend?

Timothy J. Hayes, a licensed clinical psychologist in private practice in Crystal Lake, talked with me about how dentists can manage their difficult patients. He authored two books on power struggles and has taught classes on communication skills. With over 35 years of experience in therapy and coaching using a model that emphasizes that people possess within themselves the resources necessary to deal effectively with a wide variety of problems and challenges (www.ch4cs.com).

Brush up on verbal dexterity. One of the first things Dr. Hayes recommends to doctors of dentistry is a book called People Skills by Robert Bolton. The book can help dentists and their staff members learn how to assert themselves yet listen to others, and understand how to resolve conflicts. Its author advocates “reflective listening,” which begins with repeating to the speaker what they have just said, in a way which demonstrates understanding. Said Dr. Hayes: “This is much more than just parroting or repeating back to the person word for word what they just said.  It means putting their statement into your words and including the emotion you believe they are trying to communicate.”

Charles Larson, author of the 10th edition textbook Persuasion: Reception and Responsibility, contends that people cannot be persuaded by us. Instead, our job is to focus on what they can do to help the receiver persuade him or herself.

Defuse emotions. If the patient is highly agitated, however, Dr. Hayes said: "Be forewarned that no effective communication is possible. So the first and most important step is to defuse intense emotions in whatever way is necessary before continuing attempts at communication.” 

He recommends that staff stay detached from negative emotions, and begin with reflective listening. To help staff know what to say to irritated patients, scripted answers should be written out in response to the typical confrontational questions and comments. “These answers should be rehearsed by the staff so that they can avoid taking things personally or having to try to think when being ‘assaulted’ by strong emotion from someone who is upset.” These scripts should also include responses for questions which have not been encountered before, and which will require further "research" before being fully answered. 

How do you know if the patient has a valid point? Generally the best test of this is found by considering the source of the comment, and the number of times the comment is heard. “If one of my best patients or best referral sources complains about something — and I know them to be reasonable and level-headed — I take it very seriously. Likewise, if seven to 10 or more of my patients who tend to be reactionary or prone to complaining tell me the same thing, I take it very seriously,” Dr. Hayes explained.

Management techniques for the confrontational patient are valuable skills in and out of the dental practice. The technique of reflecting back to the irked patient, with emotional understanding — “I hear you saying you feel this is not fair and you wish it could be different” or “I hear you saying you are deeply frustrated” — is often the first step in strong communication. The rest of the content of the answers is to be determined by the individual dentist and the policies of their office, and put into writing. Then practice, practice, practice.

Janyce Hamilton is an award-winning Chicagoland freelance dental writer and editor. Send suggestions for topics to be covered, or any comments on this column, to review@cds.org.

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