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Dr. Robert M Fleisher describes how to handle different types of patient personalities and sticky situations
It is extremely difficult to go through your lifetime of practice without incurring some adversarial relationships. You must avoid or mitigate such incidents to protect your reputation and the integrity of your practice. Doctorswith great bedside manner have fewer incidents; however, it is inevitable that even they will not please everyone all the time. Learning how to handle adversarial relationships requires various strategies to defuse situations while maintaining your sanity.
There are times when you have to give in to patient demands, but it should be an exception; and when it causes tension between you and your staff, make sure you explain to them why you gave in and hear their point of view so that you remain attuned to their feelings.
If you explain to your staff in advance those situations where payment policy may be changed, you won’t be undermining their authority at the front desk. Helping a needy patient through a difficult time may be the best booster for your bedside manner as it personifies compassion. Offering a refund for a failed procedure doesn’t have to be construed as an admission of guilt. It can be a wonderful practice booster for the patient who may not have understood the prognosis issues related to his/her (Allison—do you want to use the work “or,” or just say his/her) treatment.
Financial policy exceptions need to have limitations. You don’t want to become the neighborhood banker. Sadly, some people pay bills that must be paid and put off payment to the good-hearted doctor who doesn’t have any policy about collection of fees.
Rather than sending late patients home, it may be best to have them seated and let the doctor do a cursory exam and explain why he needs them to return and be on time so he will be able to accomplish the procedure.
Doctor: “We’re lucky that today I only had to do a minor procedure. Next visit, I need much more time so please don’t be late for that appointment.”
From an associate endodontist working in a busy practice:
I worked for an office that refused to see patients if they came more than 15 minutes late. Since each visit was scheduled for 30 minutes, it could be argued that it was reasonable enough to reappoint patients coming that late. While sitting around reading a magazine, waiting for my patient, I heard her arrive and explain to the secretary how she waited in the storm for the bus to come, and it was running late. The secretary proceeded to tell the patient she would have to reschedule. I intervened and told the patient I would see her. Naturally, the secretary wasn’t very happy.
Had I let the secretary turn away this older woman, drenched by the storm, I would have validated the poor reputation this office developed over the years.
You have to have a heart and not worry so much about going to lunch late. Better yet, in your office, set up policies that prevent adversarial situations.
You cannot let a patient dictate malpractice. If the patient says he/she wants you to perform a procedure in a manner that you know would be malpractice, having them sign a waiver does not remove your liability. A patient refusing x-rays is a common example. A signed waiver doesn’t excuse the doctor’s responsibility when untoward results occur from not having the proper x-rays.
“Mr. Smith, I am so sorry that you feel this way about… (your treatment outcome; our office policy; my staff; me, etc.). The most important thing needed in a doctor-patient relationship is trust and comfort with the doctor. I want you to have the best available treatment to help resolve your problems. With this in mind, I will do everything I can to help you find a doctor who can fulfill all of your needs. I would like to recommend… (offer the name of another doctor, or the name of a hospital-based practice.)”
If you prefer to avoid making a recommendation, you can refer patients to the county dental society to help them find a new doctor. Make sure you document all the details of these encounters in the patient’s chart. Dismissal of any patient should be followed up with a letter to the patients outlining the recommendation and the offer to see them for any emergency needs for the next 30 days (check with your licensing board to see how long you have to offer emergency care to dismissed patients). This documentation helps defend against accusations of abandonment.
It’s difficult, even for the irrational, belligerent patient, to argue with your concern for their wellbeing and effort to find help for them. You can’t please the world, and there is no reason you need the added stress of an inconsiderate, nasty patient unless you like the challenge.
Staff will often run back to warn doctors about some terribly obnoxious patient. These patients may be on antidepressants or other psychotropic drugs. They may have some personality disorder that makes them adversarial with most of the people in their lives. Make your staff aware of such personality types and how to recognize them by the nature of the patient’s behavior. Another clue may be garnered by reading their medical history and noting the medications they take. Your staff will be better able to deal with the belligerence knowing there is a medical reason for the abhorrent behavior. Quite often, antisocial patients are bipolar, depressed, or dealing with some other illness. Others may just be miserable, have low tolerance for stress, or faced with family or work problems, or they may be inconsiderate of others. Once you and your staff recognize this reality, you will not take affronts personally.
Negative behaviors or comments by staff should not be tolerated. Most doctors who have great bedside manner are usually warm and caring to their staff, and the staff is usually very fond of the doctor. This positive relationship is conveyed to the patients either overtly or subtly in the way they show respect. A positive relationship with staff validates the patient’s good feelings about the doctor.
You have to be creative in order to please your patients and staff. You need to have them both on your side.
“The patient is always right” philosophy is a detriment to relationships with staff. No matter what the staff says regarding policy, if the patient complains and the doctor acquiesces, the staff may become furious, and justifiably so.
In cases where you let the patients have their way, they will love you. However, catering to pushy patients will invariably inconvenience others. There are times when you should dismiss from your practice adversarial patients who can’t get along with your staff and abide by your policies. A happy staff is much more important than a few happy dysfunctional patients.
If you find a colleague who invariably provides poor advice or treatment to common patients, you have a duty to contact this provider to make sure your judgment is valid, make recommendations, and if problems continue, consider a report to the dental board. Be courteous, professional, and friendly when you make this contact.
If a colleague contacts you in an adversarial manner, maintain a professional demeanor, listen to the complaint, and indicate you will respond to the issue after some thought. It would be best to get counsel from other colleagues if the complaint regards treatment protocol. When you get back to the provider, you can have your response and remedy well thought out and organized.
Adversarial events must always be addressed and managed in the most professional and kind manner. These tips should help you accomplish this goal, reduce your stress level, and keep your sanity.
Robert M Fleisher, DMD, graduated from Temple University School of Dental Medicine in 1974 and received his certificate in endodontics from The University of Pennsylvania in 1976. He taught at Temple University and the University of Pennsylvania and is now a member of the Affiliate Attending Staff at Albert Einstein Medical Center, Department of Dental Medicine, Division of Endodontics, Philadelphia, PA. Dr. Fleisher is the founding partner of Endodontics Limited, P.C., one of the larger endodontic practices in the United States. After retiring from practice, he now devotes his time to writing about practice management, aging and health issues, and fiction with a medical theme.
This article is excerpted from Dr. Fleisher’s recently published book,
Bedside Manner - How to Gain Your Patients’ Respect, Love & Loyalty
You can read about all of Dr. Fleisher’s methods to improve bedside manner, now available for individual and institutional purchase at www.bedsidemanner.info.
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There remains a growing belief among clinicians that obturation is to blame for endodontic failures. This notion has more recently fallen under scrutiny as researchers have discovered that the most thorough obturation can only reflect the quality of the cleaning and shaping of the canal. In fact, a number of researchers point to the thorough use of irrigants — making sure that the debris and irrigant itself are lifted completely out of the canal, not forced out the apex — as the most important determinant in the long-term success of an endodontic procedure.
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