Dear Dianne,
Recently, a patient in my chair became very angry with me. He was a new patient, and as I did my assessments, I discovered that he had periodontitis. I could see definite bone loss on the radiographs with a good amount of subgingival calculus. When I attempted to probe, he expressed frustration and said he did not feel that was necessary. I told him that periodontal charting was a necessary part of the appointment.
I attempted to show the patient the bone loss on the radiographs, but he would not even look at the monitor. When I told the patient that he had a severe case of periodontitis, he glared at me and said, “I don’t care about any of that. I want you to clean my teeth.” I said, “But, sir, you have a serious problem with your gums and the bone around your teeth.”
Then, he really scared me! He quickly got up from my chair, ripped off the patient napkin and threw it to the floor, and angrily shouted as he left, “I’m going to sue this &^%$ office!” Everybody heard it, and we were all left standing there with our mouths open! Never, in all my years of being a dental hygienist, have I had anything close to this kind of patient encounter, and I never want it to happen again. Where did I go wrong? How can I ensure that this never happens again?
Traumatized RDH
Further reading:
Tools for success in provider-patient communication
How dental hygienists can respond to negative patient remarks
Dear Traumatized,
What an unfortunate and scary experience! It sounds like this patient came in with a chip on his shoulder from the beginning. Let’s take a step back and dissect the appointment to see how to prevent anything like this from happening again.
Communication with new patients begins at the business desk with the first telephone call. I know many speakers and consultants recommend that we “give the patients what they want” to keep them happy, and if the patient requests a “cleaning,” we schedule an appointment. Your patient’s expectation was that he would get a “cleaning.” Obviously, his expectations were not met when you informed him that he had periodontal disease.
What should have happened during that first call was for the business assistant to say, “Since we have not seen you before, we do not know what level of care you will need. So, I cannot guarantee that you will getting regular preventive care. It depends on what our hygienist finds when she performs the necessary assessments and takes x-rays. I can assure you that we will provide you with the appropriate level of care for your needs, nothing more and nothing less.” A conversation like this can go a long way in preventing communication breakdowns like the one you outlined.
Ideally, it would have been best for this patient, who was new to the practice, to see the doctor first. The doctor could have performed a comprehensive examination, which includes full radiographs, periodontal assessment, restorative exam, and oral pathology exam. The doctor would have diagnosed the periodontitis and explained the need for definitive periodontal treatment. When the patient was scheduled with you, the road map for treatment would have already been established, and you could proceed with the appropriate treatment.
But alas, we do not live in an ideal world, and I really do understand why many doctors prefer for new patients to come through hygiene first. Hygienists are excellent at gathering data and performing assessments, making the doctor’s job easier.
In the future when you have a new patient in your chair, and when your assessments determine that the patient has periodontitis, here is what I recommend:
No. 1: Ask questions
Ask a few questions of your patient, such as, “Have you noticed any bleeding when you brush, especially this particular area? Have you noticed any bad taste coming from this area? Have you noticed this tooth being loose? Have you noticed this hard buildup on these teeth? Are your gums ever sore in this area? Has anyone in your family ever had gum disease?”
You do not have to be concerned with what the patient answers. Your questions will merely call attention to what you are seeing. If you have an intraoral camera, you could show the patient what you are observing. Remember, a good communicator with an intraoral camera becomes a great communicator.
No. 2: Don’t diagnose the patient
In this case, don’t tell the patient he has periodontitis. Instead, what you should say after you have called attention to the problem is this: “Based on what I see in your mouth and on the x-rays, I need the doctor to come in and take a look before we proceed any further.” Then excuse yourself from chairside and speak to the doctor privately.
The doctor will come in, be introduced to the patient, sit down, look at the radiographs and periodontal charting, and then look in the patient’s mouth. The doctor can then say to the patient, “Based on what I see on the x-rays and in your mouth, you have a chronic infection in your gums called periodontitis. I would rate the severity as (mild, moderate, or severe), and we will need to treat this appropriately to get it stopped. The good news is that this is at a treatable stage. Mary is an expert at this sort of treatment, and she will explain what we need to do.” Of course, severe cases may necessitate prompt referral to a periodontist. The point is the doctor should deliver the diagnosis.
No. 3: Win your patient’s trust
If the patient makes a comment such as, “I’ve been going to the dentist for years, and no one has ever told me anything like this,” what the patient is really saying is, “I don’t know if I can trust you.” Unfortunately, there is a fair amount of distrust among the buying public toward dentistry in general. But it is also true that sometimes patients unknowingly receive substandard care. As we all know, periodontal problems can go on for years unnoticed by patients.
The point is this: all you know is what you see that day. Never, ever disparage a patient’s former provider, even when you suspect supervised neglect. You might say, “Since I haven’t seen you before, all I know is what I see today, and there have obviously been some changes since you were last seen at your previous dentist’s office.” Patients are not stupid, and if they had been receiving substandard care, they will see a difference between the excellent care you provide and what they received formerly. They will figure it out. It is your challenge to win their trust with excellent care and a caring attitude.
I recommend you have a meeting with your doctor and business assistant(s) to review the entire communication scenario with new patients in your practice. If everyone is willing to make some adjustments and modify the protocol, you can avoid future miscommunication issues like the one that happened.
