Better Behavior by Dr. William Jacobson

 

Effective approaches to handle angry outbursts, dental anxiety, treatment refusals and inappropriate behavior from patients

by Dr. William Jacobson

• Actively listen, maintain a calm demeanor and acknowledge the patient’s feelings.
• Use nonconfrontational language, maintain empathy and avoid reacting defensively.
• Maintain a safe position so that you are not trapped or cornered.
• Agree or agree to disagree. Try to find common ground with the patient.
• Set clear limits. Inform the patient about unacceptable behaviors and potential consequences, such as calling law enforcement.
• In serious cases that endanger you and/or others, try to isolate the aggressor, evacuate everyone from the building and contact law enforcement.

Fig. 1

1. Picture boarding a flight and seeing a pilot who appears nervous and insecure. Now, picture boarding the flight again, but this time you see a pilot projecting confidence as she welcomes you aboard. Which pilot would you trust with your life?
2. Picture a flight with severe turbulence and no warning from the pilot. Now, imagine a different flight where the pilot warns you ahead of time, “We will experience a bumpy flight for the next five minutes, and then smooth sailing from there.” Would you prefer a warning?

• Assessment. Identifying specific triggers and avoiding them.
• Sharing information and reducing uncertainty. However, the amount of information patients want may vary.
• Signaling. Example: “Raise your left hand if anything feels uncomfortable or if you need me to stop. Don’t raise your right hand, as I don’t want you to bump into any sharp instruments.” Or “Use this frog clicker if you need me to stop” (Fig. 2). This helps me as I tend to get tunnel vision with my loupes and may not see a hand being raised.
• Tell-show-do. Demonstrating each step of the procedure.
• Distraction. Using audiobooks or music.
• Cognitive modification. Focusing on positive outcomes. Example: “I’m so happy you came in, and we are cleaning out this cavity today so that we can save your tooth.”
• Providing emotional support. Having a warm, friendly personality.
• Physical tools. I like to provide a stress ball for patients to squeeze during injections, which some find helpful (Fig. 3).
• Retrospective control. Provide a debriefing after the appointment. Example: “Is there anything you would like me to do differently at your next visit?”

Fig.2

Fig.3

• “Are you married?”
• “Are you single?”
• “Are you from here?”
• “What time do you get off?”
• “Can I take you to the zoo?”
• “Any plans for Friday night?”

• “I keep my personal life and work life separate. So, what is going on with your teeth today?”
• “We are not here to discuss my personal life.”
• “You are here for a dental exam. Any concerns about your teeth?”

References
1. Mostofsky, D. I., & Fortune, F. (2014). Behavioral Dentistry (2nd ed.). Wiley Blackwell.
2. Keeping Your Team Safe: How to De-Escalate Encounters with Aggressive Patients. American Dental Association (ADA).
3. Tips and Strategies for De-escalating Aggressive, Hostile, Violent Patients. MedPro Group.
4. The Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM–5). American Psychiatric Association, 2013.
5. Kent, G. G., & Blinkhorn, A. S. (1991). The Psychology of Dental Care (2nd ed.). Wright.
6. Milgrom, P., Weinstein, P., & Getz, T. (1995). Treating Fearful Dental Patients: A Patient Management Handbook (2nd ed.).
7. Patient Autonomy vs. Patient-Pleasing as a New Dentist. American Dental Association (ADA) New Dentist Blog. December 5, 2022.

William Jacobson, DMD, MPH, is a general dentist, clinical assistant professor, curriculum consultant and the author of Clinical Dentistry Daily Reference Guide, a book to help dental students and dentists with day-to-day decision-making for a myriad of clinical scenarios. The book is available on Amazon. Website: williamjacobson.net He is also a member of the Dentaltown editorial board.