Are Your Patients Disappointed?

Everyone hopes they are doing enough to stay healthy. No one sets out to be unhealthy or to ruin their smile. We all hold onto the hope that, while not perfect, our efforts will be enough. Whether or not our hopes and expectations are realistic, we can feel disappointment when they fall short.

The experts recommend five servings of fruits and vegetables a day, but I can easily convince myself that three servings is probably enough to keep me healthy. Patients are encouraged to floss at least once a day, but they hope that flossing two or three times a week is enough to avoid dental problems. They are disappointed when they learn that their efforts, even if minimal, have turned out not to be enough.

We cannot eliminate disappointment. Disappointment is difficult, but it can also be an opportunity. The poet, David Whyte says that disappointment is a call to accuracy; an opportunity for resilience. It can make us retreat, or it can lay the foundation for future action.

Even when patients react with resistance, or defensiveness, or skepticism, our challenge is to guide them gently through their disappointment and into action.

What if you saw the findings of every dental exam you do as the sum total of everything your patient has done so far to achieve good oral health? What if you believed that every filling, missing tooth and root canal was evidence of a desire for health? What if you saw deposits of calculus and plaque as the result of what your patients believed to be diligent enough home care? How might that change your attitude about your patients? How might it change your conversation with them? How can you approach your exams to more effectively help your patients work through disappointment? (Click here to learn more about “Step by Step,” a workshop designed to help you guide your patients from disappointment through to action.)

• Acceptance: Meeting patients wherever they are is a good start. Avoid assumptions about their commitment to health, their intelligence, or their ability to make good choices. Wherever they are in terms of their health is the place to begin, with no blame or judgment for how they got there. “I know you have not seen a dentist in some time, Mr Jones, but I am just glad you are here now. You are in the right place, and we’ll help you go forward from here.” 

 

• Positivity: Look for evidence of health and function. It’s easy for us to see disease and dysfunction, but it is not easy for our patients to hear about it. Without sugar coating problems, begin by using language which recognizes that there is good news. Instead of just calling out the numbers of missing teeth to an assistant you might say, “Except for the wisdom teeth Mr. Jones still has all of his teeth” Or, “It looks like decay has been a problem for you and that you have had fillings to help you keep those teeth. Some of those fillings are still holding up quite well.”

 

• Involvement: The more passive patients feel in the exam process the less likely they are to take ownership of the present conditions and look for solutions to problems. Inviting patients into learning about and solving their own problems encourages ownership. I like to place a mirror in the patients hand at the beginning of the exam and ask them to hold onto it in case I have questions for them. Then I will look for any excuse to invite them to bring that mirror up and I ask them something. “Is this where you mentioned you sometimes catch food?” Or “Is this where you had teeth extracted when you had braces?” Even if I can figure out the answer for myself, there is value in seeking their input. I can help them feel more confident in their knowledge and more engaged in the process.

 

• Honesty: Patients have a right to know what about what we see and the risks involved. We cannot hold back information about the conditions present in their mouths. “You have lost about 50% or the bone around these teeth which causes them to be less stable.” We do not need to overwhelm them with details or with recommendations, but we do have a responsibility to help them understand our concerns for them based on our experience. “Typically when I see this at this point in your life, I’m concerned that eventually we will see . . .”

 

• Description: Learning to describe what you see without evaluating is a powerful skill to develop. We find value in naming conditions and evaluating them as good or bad. But our patients are more likely to respond favorably to an unbiased description of conditions. “I see openings around the edges of this filling where bacteria can easily hide and grow.” “I see bleeding when I gently slide this instrument in the space between this tooth and the gum around it which I don’t see in these other areas. Bleeding here is not a sign of health.” Give them the opportunity to ask what that means or what they can do about it.

 

• Compassion: Just understanding and acknowledging their disappointment can support them in moving on. Avoid going too quickly to suggesting solutions to problems they have not yet fully accepted. “What are your thoughts about what we have found so far, Mr. Jones? How does this fit with what you expected?” or “This must be difficult to hear. I’m guessing this is not what you had hoped for today.” Pause to let them process and respond. Let them know they are in charge. “Where would you like to go from here, Mr. Brown?”

 

• Hope: If we give up on them they are more likely to give up on themselves. Whatever their history has been they can change the future. The more we understand that history — their choices, their assumptions, their disappointments — the more we can help them see new possibilities. Invite your patients to partner with you to identify realistic goals and expectations. Create a dialogue about the part each of you can play in accomplishing those goals. When hope flows out of accurate risk assessment and clear agreements it is based in reality. That type of hope goes a long way in avoiding disappointment.