When patients tell us things they probably shouldn't, and what you can do about it
by Cathleen Terhune Alty, RDH
Dental professional, or confessional?
It's a normal day in your normal practice in a normal town. You're just getting started when your patient decides to confide in you … things … very personal things, such as a divorce, drug use … 50 shades of things you don't want to know about. You're a good listener, and you've worked hard to build rapport, openness, and a good chairside manner with your patients. But you feel your cheeks flush when this patient begins to confide. He continues and your discomfort grows.
While we may be flattered that patients trust us enough to share their personal problems with us, is it appropriate? Can it cross a professional line? And who might be listening?
Most dental hygienists can relate to this scenario because our regular patients commonly share what's new in their lives as part of their appointments. Sometimes that sharing may be about more than the last vacation.
"I believe that the reason patients confide personal information in us is because the conversation has evolved to that level," says Laura Jamison of Jamison Consulting. "It happens when a speaker perceives that the receiver is truly listening. A good listener feeds back what is heard, and once a patient feels comfortable that the individual is actually tuned in, he or she may feel it is safe to express thoughts, opinions, and feelings. There is also an aspect of comfort that comes from relating personal information to a health-care provider because there is a less ‘personal' relationship; it's safer because the information will not be leaked to close friends and family members."
It's not only trust and a good bedside manner -- for many fearful patients, their nerves put their mouths in gear and they may not be able to stop themselves. A patient in personal crisis may also have dental issues as a result of the stress. Dianne Glasscoe Watterson, RDH, practice management consultant, author, and RDH magazine columnist, said this depends on the crisis.
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"The stress from a messy divorce can wreak havoc with the tissue, so it's not a bad thing for the dental professional to know about the divorce," she said. "But the details are unnecessary. Patients usually want sympathy when they share the details, and some patients just need a friend. I've always felt that if a patient opens up and shares a personal trial or heartache, the hygienist should consider it a compliment, because it means the patient sees the hygienist not just as a caregiver, but as a friend. The key is NOT to offer advice, just a listening ear."
For example, a common personal crisis is the messy divorce that involves "he said, she said," and both spouses are patients of the practice. It is best to say how sorry you are about the situation, and tell them that you value your relationship with them too much to take sides.
A tight schedule can make us cringe when the lonely elderly patient needs someone to talk to. Jamison said, "I believe that extra time can be built in to an appointment for a senior who likes to visit, or for someone with an expressive personality that likes to chat. It's the best form of internal marketing to give patients an experience they can appreciate." She adds that we should always direct our questions back to their dental issues.
Obviously, if a patient discusses abuse, either as the abused or the abuser, it should be taken seriously and reported to the proper authorities. A dental professional is required by law to report cases of abuse or neglect. Domestic violence, dating abuse, child abuse or neglect, sexual assault, and elder abuse should be reported so the victim can get assistance.
Maybe it's not personal information but controversial topics that a patient wants to discuss. Sensational headlines with polarizing political rants are probably not good to discuss with patients. Watterson said, "One thing I learned from a former boss is that when a patient brings up a controversial topic such as politics or some hot-button issue, and asks what you think about it, the best way to address it is to say, ‘Well, tell me how YOU feel about it.' Then say, ‘That's very interesting.' Stay neutral on controversial subjects, and say, ‘You've given me food for thought,' or ‘You've put a lot of thought into your beliefs.' Reflect back on the person, not yourself."
Unfortunately, conversations with some patients can quickly go from innocent to bawdy. "I had a dirty old man in my chair one time, and he kept staring intently into my eyes while I worked," says Watterson. "I felt like he was undressing me with his eyes. He did auto body work for a living, and I casually mentioned, ‘I see you do body work,' which was definitely NOT the thing to say to this creep. His eyes lit up and a big grin came across his face when he said, ‘Yeah, baby, I do BODY work.' Oh my gosh, I nearly died from embarrassment!"
She continued, "In my very first job as a hygienist, I had a married man ask me for a date. This jerk's wife was also my patient. He said, ‘You know, this weekend is going to be beautiful weather. How about you and I spend the day at Carowinds?' (a big amusement park in Charlotte). I thought he was joking, really. I said, ‘Actually, I'm married, and your wife might not think much of that idea.' He said, ‘Who cares? Let's go have a good time!' My boss heard the conversation and rushed in to save me. I was very naïve. After the patient left, my boss told me this guy was a known womanizer. Sheesh!"
Watterson says, "If a conversation turns sexual, the hygienist should be frank and say, ‘I'm not prepared to discuss these personal issues with you,' and redirect the conversation back to dental topics. My mantra is patient conversations should be 75% dental and 25% other."
The tables can be turned on this problem, as often hygienists share personal things with patients that they shouldn't be sharing. Because relationships usually go both ways, it might seem natural to talk about an issue that is the focus of our attention. But as health-care professionals, we have an obligation to remember who is being served, and it's not us. It is essential that a patient and his or her concerns be the focus of every dental visit.
If we have a bad day, it's better to email a friend or do some quick stretching and stress reliever exercises before sharing personal details with patients. If a patient is a personal friend, sharing your personal details outside of the appointment time and the office is the best policy. They may seem interested, but patients really want the appointment to be all about them. They are paying us to take care of them, which sometimes means we're going to be told some personal things that we'd rather not hear.
Learning how to listen and deflect with grace is yet another interesting skill to add to our dental hygiene career. RDH
Cathleen Terhune Alty, RDH, is a frequent contributor who is based in King George, Va.
Resources
Reporting child abuse and neglect by state https://www.childwelfare.gov/pubs/reslist/rl_dsp.cfm?rs_id=5&rate_chno=11-11172
National Center on Elder Abuse http://www.ncea.aoa.gov/
Domestic Violence http://www.ncadv.org/files/DomesticViolenceFactSheet(National).pdf
National Center on Elder Abuse http://www.ncea.aoa.gov/
Crossing the line
When is a patient's sharing over the line? When you start to feel uncomfortable -- blushing, nervous, speechless. You have the right to stop someone when you feel they have crossed the line. How do you do this gracefully when you don't want to burn the bridges you've worked so hard to build?
You can start with body language. Break eye contact. Lean away from the patient. Certainly picking up your instruments and being poised over the mouth as if you need to get back to work helps. So what can you say to the patient when things are getting uncomfortable?
Jamison said, "Here is a great tip ... remember that the person in control of a conversation is the one asking questions. If an uncomfortable path of dialogue begins, ask a deflecting question. For example, a hygienist may get a very personal response to her or his inquiry of the medical history. It is appropriate to give feedback based on the information gathered -- ‘It sounds like that was an upsetting experience.' The patient may expand on the answer, and again it may be appropriate to give feedback on what is heard, and then ask a question that will bring the topic back to dental care, such as ‘What dental concerns shall I pay particular attention to today?' or ‘Last time you were in we noted some areas of infection. How often have you been flossing since then?'"
Or try some humor. "Hmm. You might want to stop because the statute of limitations may not be up on that." "I hear what you're saying. Gee, I hope no one else can." "We'd probably better get some work done in here or I'll be out of a job."
Open concept office spaces with partial walls and open doors means conversations carry to all parts of the practice. How embarrassing would it be for a patient confiding personal information to hear comments from a patient in the next room, or overhearing staff in the room next door discussing your patient with the assistant? I've experienced this and it is very disconcerting. Music in each operatory helps mask the words enough that eavesdroppers can't hear exactly what is being said.
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