Managing challenging patients during the pandemic

swearing patientMartin Wanendeya delves into the research behind an increase in assaults on healthcare professionals since the beginning of the COVID-19 pandemic.

Freedoms continue to be restricted by the COVID-19 pandemic. It is no surprise that there is palpable tension within the general public as patience is running thin.

Frustration is inevitable amongst dental patients. Most patients were unable to access the treatment they needed during the nationwide lockdown in 2020. They suffered from prolonged pain and/or comfort as a result.

Although some practices have reopened, dental professionals who have returned to work are coming up against further obstacles to the provision of high-quality care. As well as adapting to additional personal protective equipment requirements, dental teams have had to modify the way they work in order to adhere to relevant policies and guidelines. This includes those related to fallow time and disinfection.

Clinicians are also worrying about their health and that of their families, colleagues and patients. This is in addition to facing a backlog of patients with outstanding treatment due to unavoidable delays caused by the pandemic.

Verbal or physical abuse

Many dental professionals have expressed concern over their mental health and wellbeing. Therefore, it is disappointing that not all patients are equally understanding of the current circumstances.

A recent survey by Dental Protection revealed that a third of dentists have experienced verbal or physical abuse from patients or patients’ relatives during the pandemic. This is primarily as a result of not being able to offer an appointment soon enough.

A further 5% of dentists have even been subjected to verbal abuse outside of the practice. Sadly, the current health climate seems to have only exacerbated the problem of aggression towards those providing essential services.

According to the Union of Shop, Distributive and Allied Workers, retail staff have been assaulted, threatened or abused at least once a week on average since the start of the pandemic, compared to once a fortnight in 2019.

Attacks against healthcare professionals were already increasingly documented before the COVID-19 outbreak. However, there is substantial evidence from the World Health Organisation and McKay and colleagues (2020) that the number of these incidents has risen sharply in the last year.

According to www.bbc.co.uk and www.local.gov.uk, council workers and police personnel have also been targets of abuse during the crisis.

The reasons for the increase in assaults against essential workers over the course of the pandemic are varied. They are complex and often related to local factors. The unfortunate reality for those within the dental profession is that many people do not like visiting the dentist and already associate treatment with strong, negative emotions such as fear, anxiety, pain, distrust and anger.

Some people may have had poor past experiences of dentistry, which can heighten their feelings of vulnerability and lead to aggressive or violent behaviour in practice.

Fear of the dentist

It was reported on www.anxietyuk.org.uk that almost half of UK adults have a fear of the dentist, with 12% suffering from extreme dental anxiety or phobia.

It is these emotions, in particular, that can easily breed frustration and anger among patients, especially in an already high-stress situation such as pandemic, where access to timely dental care may be limited.

Patients’ scope of tolerance for delays in receiving treatment may also be exacerbated if they are in pain or discomfort. Nevertheless, there are steps clinicians can take to manage difficult patients, which primarily relate to good communication.

It is important that dental teams follow a policy of zero tolerance towards aggression and violence, to deter this behaviour. The policy should set out how abusive and threatening actions from patients will be treated. It should also be readily available for both staff and patients. Perhaps, on a noticeboard in reception and/or on the practice website and social media channels.

Being aware of a patient’s potential to become challenging is crucial in order to prevent a situation from escalating. Therefore, pay attention to patients’ body language, what they say and how they say it. It can indicate increasing frustration and anger.

Communication

You can reduce tension by acknowledging the patient’s feelings. Also, by demonstrating a willingness to listen to their concerns and help, if possible.

Asking open-ended questions and avoiding encroaching on their personal space might also help to calm the situation.

Furthermore, you should fully communicate the protocols you now have to follow as a result of COVID-19 restrictions, to patients. Some of whom may just be confused or lack an understanding of why their treatment has been delayed.

Other patients might simply be anxious that you are only able to offer limited treatment options at the moment. In this case, you can always refer to a trusted clinic, such as Ten Dental+Facial. The multi-award-winning team has the necessary protocols and PPE to be able to support your practice and patients with both simple and advanced treatments. These range from dental implants to general dentistry and specialist procedures.

Managing difficult patients is never easy or pleasant, but there are ways we can defuse potential confrontation effectively. It is important to remember that the number of patients presenting challenging behaviour in the dental practice remains a minority.

In the face of increasingly uncertain times, it is reassuring to know that kindness continues to prevail.   


Reference

McKay D, Heisler M, Mishori R, Catton H, Kloiberm O (2020) Attacks against health-care personnel must stop, especially as the world fights COVID-19. Lancet 395(10239): 1743-1745

This article first appeared in Dentistry magazine. You can read the latest issue here.

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