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How to become a knight in shining armor

June 1, 2020
During 40 years of practice I’ve been part of numerous disputes and learned that my choices are to cross my fingers and hope to muddle through or face the challenges head-on and learn to manage them masterfully.

Have you ever heard this? “Doctor, my tooth never bothered me until I let you talk me into spending a small fortune for a crown. Last night I woke up with this terrible throbbing pain. You caused this. How are you going to fix it?”

If you haven’t experienced a scenario similar to this, you probably haven’t been practicing dentistry very long. Few people enjoy conflict with its concomitant sweaty palms, dry mouth, and mild tachycardia; yet it is an unavoidable part of dentistry and life. During 40 years of practice I’ve been part of numerous disputes and learned that my choices are to cross my fingers and hope to muddle through or face the challenges head-on and learn to manage them masterfully. 

Although at first blush it may not appear so, when handled appropriately the above scenario is an opportunity to enhance your professional reputation, bond with your staff, and improve your relationship with the patient, his family, and his friends. Toward those worthy ends, allow me to share a few hard-won lessons in the hopes of making your career and life more pleasant, peaceful, and profitable.

What I’ve learned

Critical to success is to maintain a mindset that considers this a problem that you and your patient share, not a battle that someone wins. Defensive reactions can heighten conflict, so listen silently as your frustrated and exhausted patient’s litany unfolds. Pay close attention and take notes until he finishes venting. If your only responses are nods with a concerned, sympathetic frown, he’ll eventually quit talking. 

Sure, he hasn’t been to your office in five years, you didn’t cause the tooth to decay or break down, and you had shown him on the x-ray how close to the nerve the damage was. These facts might be germane in a court of law, but they’re of little import when your suffering patient sits three feet away. 

When it was my turn to speak, I looked directly into this patient’s eyes and stated, “I’m terribly sorry this happened. Let me examine the tooth and find out what’s causing the trouble so I can fix it and stop your pain.” Let’s parse this statement: I’ve been counseled by insurance companies to never admit culpability, and I did not confess to any wrongdoing. I have expressed heartfelt solicitude and stated my intention to make him comfortable and work to resolve this problem. 

A patient’s concern that often goes unstated is the fear of being abandoned when in dire straits, so a portion of this patient’s antagonism is a desperate and understandable cry for assistance. Knowing I am unequivocally on his side and that we share common goals reassures him. Nota bene: my assertions establish control of the situation, which is appropriate as I’m the only one who can help. 

As a compassionate health-care provider, you’ll want to relieve pain. Once you’ve made a diagnosis (in this case perhaps hyperocclusion, the acute pain triggered by nocturnal bruxism), administering a long-acting anesthetic will make both of your lives easier as pain-free people tend to be more reasonable, even grateful.

Consider times when you’ve needed help. How often have you been met with a stonewall of excuses and a cavalier, “Not my fault, not my problem” attitude? It’s infuriating! What you want and what we all want is a knight in shining armor who, instead of quibbling and denying, declares, “Don’t worry! I’ve got this!” 

As an aside, if post-crown endodontic treatment is needed, who pays? If it was estimated—and shrewd dentists include this contingency in virtually every crown prep treatment plan—it’s the patient’s obligation. If not, I split the fee 50-50, or accept insurance reimbursement as payment in full. It’s shortsighted to chase dollars here. To paraphrase Aesop’s fable of some 2,600 years ago, it is hard to regain a lost reputation. Focus on patient well-being and become known as the dentist who will do whatever it takes to make things right. Situations like this are occasions to earn goodwill.

More conflict possibilities

Here are other sources of possible conflict. On several occasions I’ve been presented with a large plastic bag filled with dentures that “don’t work.” I’ve also heard new patients describe in detail the numerous deficiencies of their previous six dentists. As a fledgling I may have considered the aforenamed denture patients as an interesting challenge and believed I could somehow triumph where a half dozen of my colleagues had failed. But over time I disabused such conceits. Sometimes, it’s best to just say no.

Or consider the patients who, when mentioned during the morning staff meeting, elicit a collective groan and the fervent plea, “Please not in my room.” I decided long ago that I won’t allow such people to ruin our day. Dentists have to be the bosses, so I don’t delegate patient dismissals or terminate relationships with a phone call or email. I sit beside the person, make eye contact, and start the conversation. “I’m sorry, but I’m not a good dentist to care for your needs.”

“I’m sure you are.” 

“No. I simply am not.”

“Well, who would you recommend?”

“I really can’t name anyone specifically.” (I don’t want to go to a dental meeting and encounter a colleague striding toward me and muttering through tight lips, “Thank you so much for the referral.”)

After swallowing sufficient ego and telling the patient this, I’ve never had a patient fail to leave, or even make a fuss, which was my goal. By humbly, yet bravely excusing the patient-demon, I become a hero to my relieved and much happier staff. 

Information not acted on is mere entertainment, and there are many ways your practice can make these strategies your own. I believe these concepts to be eternal verities, as applicable to family, staff, neighbors, and friends as to one’s office. Dentistry is challenging enough when everything goes well. Over the course of a long and rewarding career, I discovered that nothing is more important than working with friends in a positive, peaceful atmosphere. I wish you the best.  

JOHN A. WILDE, DDS, practiced in Keokuk, Iowa, and is now blissfully retired. He’s written six dental books and had more than 200 articles published in a wide variety of journals. He may be reached at (309) 333-2865 or [email protected].

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