What strategies can a dentist use to discuss sensitive topics with patients?
Make notes of planned points of the conversation prior to meeting with the patient. This will help keep the discussion factual and on topic. It may be helpful to offer the patient time to think about your discussion and continue the conversation at a later date.
Determine which parent is able to consent to treatment for the child, and whether the consent of both parents is required. In some circumstances, a parent who is not able to consent to treatment is still entitled to receive personal health information related to their children.
Ask both parents about their legal authority to obtain information about their children and make decisions about their children’s care. The word of one parent should not be taken as definitive, even if that parent normally attends appointments with the children.
The College’s Practice Advisory Service can also assist dentists in managing situations such as these.
Signals may include:
- a change in the patient’s tone of voice
- aggressive, violent or physically threatening behaviour
- body language that suggests distrust
- a family member who takes a hostile tone or makes demands on behalf of the patient
- “second guessing” previous dental advice
- seeking multiple copies of dental records
Even if you experience some of this behaviour, take into account the entire professional relationship, including steps that have been taken to improve it and positive steps that could still be taken when considering whether it can be salvaged.
If you are considering dismissing a patient, notify them of this possibility without being threatening. Advise the patient that if the conflict cannot be resolved then it may be in their best interest to seek treatment elsewhere. Set out clear criteria so that both parties understand under what circumstances the professional relationship would be terminated.
The purpose of offering to see the patient on an emergency basis following dismissal is to allow the patient time to find a new practitioner. How long that lasts will depend the patient’s clinical condition, the nature of the care required, local availability of care, and the patient’s ability to travel and/or make alternate arrangements with a dental practitioner. Some patients have insurance coverage that is not accepted by all offices. This may be a factor in a patient’s ability to get care from another practitioner, especially in smaller communities. If you are considering putting a time limit on the offer to see a patient on an emergency basis, subject the factors above, you should plan to provide that care or at least one to two months.
Ensure that the patient is aware of their clinical condition, the treatment needed and the timeliness of the treatment as well as the risks of not completing the treatment. Consider giving the patient information about any outstanding treatment in writing so they can provide it to their new dentist.
Plan for patients who have a written agreement with the dentist about ongoing treatment (e.g. orthodontic treatment). Tell the patient that the treatment covered under the agreement will not be completed and that you will return the fees for any outstanding treatment to the patient.
Remember you must continue to see the patient on an emergency basis to allow them time to find a new practitioner.
It is not usually necessary to formally dismiss the patient if they have complained to the College about you. More often than not, the patient who has complained to the College about you has no interest in returning to see you for further treatment, so the dismissal letter is unnecessary. If the patient does attempt to return to see you in the future, the dismissal letter, if there is justification, could be sent at that point. There are exceptions to every case, so if you have any uncertainty, call Practice Advisory for advice or Professional Liability Program or to discuss the specific case.
True dental emergencies can include prolonged pain that cannot be managed by over the counter medication, swelling, trauma, and unexplained or prolonged bleeding. The patient should be seen as soon as possible to be assessed by the dentist. Dentists should leave time in their schedules to attend to emergencies. Although it is ultimately the responsibility of the dentist to determine if it is a “true” emergency, they can train the staff to ask patients specific questions and then consult with the dentist to determine how soon the patient should be booked to be seen.
