Consultations without confrontations – managing challenging patients

confrontationsThe DDU’s Simon Kidd looks at how to keep your cool when faced with challenging patients. 

Difficult interactions with patients are nothing new. But over the last two years they have become a dispiritingly familiar experience for Scottish dental professionals.

Sadly, the pandemic has created the ideal conditions for conflict. Stress, grief and financial hardship have heightened emotions and shortened tempers.

At the same time, dental practices have been forced to interrupt courses of treatment, limit appointments and restrict the procedures they carry out. While most patients have been understanding, some have been unable to contain their frustration.

In January 2022, the Scottish government launched a Stakeholder Toolkit for Violence and Aggression as part of its Respect campaign to reduce attacks on healthcare staff, including dental professionals.

Unfortunately, it could be some time before dental services return to normal. According to the latest statistics from Public Health Scotland, the number of patients seen in 2021 was less than half when compared to 2019.

In this climate, dental professionals will need to rely on all their communication and patient management skills to pre-empt conflict and respond appropriately to challenging behaviour. The following tips should help.

Manage expectations

Most patients are aware of the limitations of the care that you can provide. But it is good practice to be clear from the outset about what is possible. As well as what you aim to achieve and how long it is likely to take.

It is much easier to set realistic parameters for care at this stage than try to reason with a disappointed and angry patient who believes they have been misled.

Ensure practice communication is clear and consistent

All patient interactions have the potential to go wrong, not just those in the dental chair.

To avoid misunderstandings, ensure patients receive consistent and clear information at every point of contact: practice noticeboards, website, answerphone messages and staff.

Regular team meetings should also help ensure all members of the team are up-to-date with policies and procedures. For example, explaining the Covid security measures in place before patients attend, how patients can access urgent treatment etc.

Recognise warning signs

Body language and tone can indicate increasing frustration and anger. So it’s important that those in patient-facing roles look for non-verbal signals such as increased redness in the face, staring, scowling, a raised voice, restlessness and agitation/irritability.

Defuse tension

If you notice these warning signs early enough it is possible to take steps to calm the situation.

Reduce tension by remaining calm and professional, asking open-ended questions, providing reassurance and not encroaching on the person’s personal space.

Be assertive without being aggressive. For example, responding with: ‘I can try and help you sort this out. In order to help you, I need you to provide me with a few more details so we can discuss the best options for you…’

Put problem behaviour into perspective

It should be easier to stay calm if you are able to see things from the patient’s perspective. Recognise their behaviour may be out of character because they are frustrated, in pain, have dental anxiety or are worried about the cost of treatment.

By showing them that you understand their situation, you can help the patient feel listened to and supported and get then back on side before it’s too late.

Support colleagues

Make an effort to look out for colleagues and check in with them if they have a difficult interaction or a tough day.

Staff who are valued and supported should feel empowered to deal with challenging behaviour.

It can also help to hold a supportive team meeting after an incident so those involved can discuss learning points.

Organise staff training

All members of the team should receive regular training and updates on how to identify and manage aggressive or abusive behaviour. As well as appropriate routes for escalation in line with the practice zero tolerance policy.

This should also help to reassure them that the practice will support them.

Enforce your zero-tolerance policy

The policy should set out what constitutes abusive and threatening behaviour from patients. As well as the possible consequences, including the ultimate sanction.

It should be readily available on a notice at reception, in the practice leaflet and/or on the practice website.

It is important that everyone commits to enforcing it. If a patient feels they can get away with being abusive or aggressive, they are unlikely to stop. And others could follow their example.

Follow correct steps if you need to remove a patient

The NHS GDS regulations in Scotland recognise that it may be necessary for the practice to terminate its relationship with a patient if they are abusive or aggressive.

To remove a patient from a registered list, complete a GP200 form. You can obtain this from your local NHS board.

This form will ask you to state the reasons for your request. However, before completion it is worth contacting the Health Board and your dental defence organisation to explain the circumstances as to why you have taken this decision.

The GDC says you must be satisfied that your decision is fair. It adds you should write, informing the patient of your decision and the reasons for it. And that you should make prompt arrangements for the patient’s ongoing care.

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