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Mastery in Times of Dental Patient Conflict by Dr. John A. Wilde

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Categories: Practice Management, HR and Accounting;
Mastery in Times of Dental Patient Conflict 

How do you respond when unhappy patients show up?

by Dr. John A. Wilde

Even I manage well when my office is peaceful and productive, but no level of effort and determination can assure perpetually perfect outcomes and an endless stream of appreciative patients. As in every life, a little rain must fall, just as certainly conflict is inevitable even within the most sophisticated and patient-oriented practices. But since trouble arrives in countless guises, often without warning, the question is, will one handle such situations with professional aplomb or dither and distress? I define behavioral mastery as being able to consistently exhibit excellence under stress. Developing this skill is essential for dentists who wish to enjoy practicing and prize a tranquil mind and restful night’s sleep.

Few welcome discords and some are utterly terrified of it, especially after realizing it’s impossible to “win” these conflicts. One’s goal should not be to triumph but to reach a mutually acceptable resolution, because even if truth and justice are on your side, consumers are the ultimate judge and jury. Sadly, most of us have encountered unhappy patients—and sometimes even staff—who convict the dentist of wrongdoing, despite a dazzling display of evidence sufficient to persuade the most recalcitrant and skeptical observer of innocence. Irate individuals then broadcast their guilty verdict far and wide, to the detriment of the dentist and practice. (Experts claim an unhappy consumer will tell 11 people of their displeasure, while a satisfied one mentions it to three. Daunting odds.)

Even among the enlightened few who understand these battles are unwinnable, it seems natural, almost instinctive, to react defensively to complaints that can feel like personal assaults. And that’s precisely why preparation is essential, because such innate protective behavior can escalate the conflict. What follows is a concise, four-step formula that enables me to confront discord with proficiency and composure.

Four cornerstones to behavioral mastery
  1. The first step toward ideal conflict resolution is actively listening to and agreeing with the complainer. Stating, “I understand your frustration. This isn’t the outcome I wanted, either,” is not an admission of wrongdoing.

  2. Once there, remain on the patient’s side. It’s hard to continue protesting when one’s interlocutor agrees with every statement, yet it is vital to allow the aggrieved party every opportunity to vent fully. Only a thoroughly drained wound can heal.

  3. Accept responsibility. That doesn’t mean I caused the problem but establishes me as the person to set things right. Embracing responsibility is the mark of a mature person and doing so definitively puts me in control.

  4. Co-develop a plan. Once the patient and I are firmly on the same side (and their emotional energy is released), we craft a mutually acceptable strategy to create a resolution.

Let’s consider a “hypothetical” example (which happened to me, of course) of behavioral mastery in action:

It’s early Monday morning, and the office is humming along, busy but productive, when my rabbit ears detect a raised voice emanating from the reception area. Soon my slightly shaken but not stirred receptionist hands me a folded note.

Mr. Tom Schmidt has walked in without an appointment. The MODL restoration I placed on #30 six months ago has fractured, the tooth is sensitive, and he is angrily demanding to see me posthaste.

I ask my receptionist to seat Tom in my private office and offer him coffee and this morning’s paper. She’s to advise him I’ll be there in approximately 10 minutes. (Nota bene: Don’t be late.) I also ask her to bring his record, but I don’t need help remembering Tom.

A huge, hulking dairy farmer, he was extraordinarily apprehensive, a challenge to get numb, with a tongue whose size and mobility made me suspect he was an alien lifeform. Before reluctantly placing this restoration, I’d informed him an onlay was indicated and noted this recommendation in his chart. While I am clearly on the side of the angels, behavioral mastery, not mere facts, is required in this emotionally charged situation.

Seven minutes later, entering my private office with a cordial smile (or as close to one as I can muster), I look him in the eye, offer my hand, and say, “Good morning, Tom. I’m sorry to hear you’re having a problem. How may I help?”

Tom has been pacing but takes my hand reluctantly and says, “That expensive filling you just put in broke. It hurts to bite, and I can’t stand cold anywhere near the tooth. I want to know what you are going to do about it!”

“I’m sorry to hear that, Tom. Let me assure you that while I’m not perfect, I am honest. I’ll do whatever it takes to fix you up.” (“Not perfect but honest” is the truth, and logically or not, it generally elicits a positive, understanding response. We are all fallible. Let he who is without sin cast the first stone.)

Note that I’ve already mentioned my regret twice, and sympathizing may be more critical than not charging to correct the problem. It is more authentically personal, thus more powerful emotionally, and establishes that I’m on the patient’s side. Delivering any meaningful communication in a friendly manner after using the patient’s name, establishing direct eye contact, and initiating some form of physical connection, be it a handshake or light touch, will exponentially increase the effectiveness of any message. While this is decidedly not the most natural or customary way to confront anger, with iteration, it gets easier.

Tom continues to vent but soon loses steam as I keep agreeing with him. “Let’s get you in a chair immediately. Sally can take an X-ray and an intraoral camera image. I want to be sure we know everything necessary to fix the tooth ideally.” I respond to his question by assuring him there will be no charge for today’s imaging and emergency examination.

No abscess is radiographically evident, so I show Tom the photo, remind him of our onlay discussion (if necessary, show him my note), and offer to cover and protect the weakened tooth while deducting the original fee from his bill.

Under the above circumstances, most patients accept the fixed restoration; thank us for seeing them promptly and being fair by deducting the earlier charge. But no behavior can control other’s actions or emotions, so I’ll gladly refund his full fee if this offer doesn’t satisfy.

And if this doesn’t work?

Whatever the resolution, I think dentists must consider if they wish to continue treating an unhappy patient. Their association’s background could be telling a factor. If the individual has been a loyal patient who keeps appointments, pays promptly, refers friends and family, and this is an isolated event, I tend to overlook it. But, in the above instance, our history was brief and unpleasant. Tom was a demanding, disagreeable patient who was extremely challenging to treat. I wrote a check for a full refund on the spot, handed it to Tom, shook his hand, and wished him luck.

Over the years, I dismissed numerous individuals, some immediately after their examination when noncompatibility became evident. Once I decide to terminate a relationship, I’ll look the patient in the eye and say, “I’m sorry, but I’m afraid I’m not a good enough dentist to meet your needs.” The fact that they had scheduled with me suggested they at least hoped I could solve their problems, so they would usually disagree, but my decision was unwavering. If asked who I would recommend, I’d regret that no one came to mind. I didn’t want to meet a gimlet-eyed colleague at our next study club and have to explain why I’d dumped this mess on them.

My goal was to get rid of an undesirable patient quickly and without unpleasantness. It requires a modicum of humility to admit you cannot solve every problem for everyone, but swallow your pride because preemptive action can save a lot of misery. Also, dismissing patients that the entire staff dreads makes you their hero. A dentist must accomplish this uncomfortable task in person, not delegate it to a staff member. If you want to be the boss, you have to act like it.

Final thoughts

If one accepts responsibility for a problem, does this make a lawsuit more likely? I’ve been advised of this possibility by insurance representatives, but that’s not been my experience. I was fortunate to practice 40 years without being so much as threatened by a suit, although legally, these qualifications count for naught. Still, I believe those who take responsibility are seen by others not as weaklings, cowards, or failures, but as people of courage, character and strength. In short, the kind of person we all admire and perhaps hope to become.

But don’t take my word for this. Reflect on personal experience. When something you’ve purchased or a service you’ve paid for fails, how do you react to excuses? When a recently repaired unit continues to drip water, is it an explanation you seek? When office problems occur, how do you respond to staff explaining why it isn’t their fault?

In times of trouble, one desires a paladin to appear and masterfully resolve the dilemma because fixing the blame doesn’t fix the problem. I believe people’s positive reaction to your forthright and good-natured acceptance of responsibility will astound you, as it has indeed become a rarity in our it’s-not-my-fault victim’s world. Making this choice in every venue of life will also allow you to grow closer to becoming the person you wish to be: a calm, happy individual, confident of retaining mastery, even in the face of daunting disputations.


Author Bio
John Wilde After working through eight years of higher education, paying 100% of all costs, Dr. John A. Wilde spent his next two years in the U.S. Army Dental Corps before beginning a practice from scratch in Keokuk, Iowa. He was debt-free at 30 years old, owning his home and the practice he’d designed and built outright. He was financially able to retire at 40 and fully retired when he was 53. He has published six books and written more than 200 articles. Contact: 309-333-2865 or jwdentist@hotmail.com

 

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