Having difficult conversations with patients

“I’m sorry, Ms. Jones, the tooth cannot be saved and must be extracted.”

“Unfortunately, Mr. Smith, that service is not covered by your insurance.”

“During the procedure, we exposed a pulp horn, which will require a root canal.”

These are three examples of how tough conversations with your patients can begin. If you’ve experienced clinic, I suspect you have had at least one of these conversations with a patient. Having these types of talks is one of the hardest parts of our job and can occur every day. As dental professionals, it is our duty to report the facts about our patient’s oral health to them. Once the patient is informed, they are tasked with making a decision about the course of treatment. How can we make these conversations easier for ourselves and our patients?

Recently, Forbes published an article about approaching difficult conversations in the workplace. It outlined the comments of 14 Forbes coaches; I will summarize the ones that can be easily applied to dentistry.  

1. Step into the patient’s shoes. What factors have led the patient to his or her current oral status? Are finances involved? Are there modifiable risk factors that can be altered? It comes down to knowing your patient, which can be hard if it is the first appointment. Find out what factors are motivating the patient and use that to help improve their oral condition.  

2. Stick to the facts. This is embodied in the American Dental Association’s Code of Ethics principle, veracity. Always tell the truth to the patient, even when it is difficult. Patients are trusting you with their oral health and should be told the facts, which will allow the patient to make an informed decision about the course of treatment.  

3. Be empathetic. Similar to stepping into the patient’s shoes, it is important to show that you care about the patient. If we did not care about helping people, we would not be in the dental profession. Let patients know that you are on their side and are willing to help. This can be a relief to those who have avoided the dentist for years.  

 4. Do not take it personally. If the patient becomes frustrated or disagrees with the diagnosis, it’s not your fault. These conversations can cause unrest, especially when teeth cannot be restored. After explaining the findings to the patient, they have the right to make treatment decisions, including no treatment at all.

5. Use the “bad news sandwich.” The bread of the sandwich is two things that the patient did well. The meat of the sandwich is where the patient can improve. Patients who neglect their teeth can have numerous problems in their mouth when they sit in the dental chair. Try to reinforce the good things that they have done. They came to the appointment, which is the first step to improving their oral health.

This is merely a snapshot of how to handle difficult conversations in the dental setting. It requires experience and knowing your patient. For more information about conversing in difficult situations, I encourage you to read Crucial Conversations: Tools for Talking When Stakes are High.

~Jerad Servais, Minnesota ’18, electronic editor