Evelyn Ferguson-Williams, Dental Protection Case Manager, and former dental nurse, looks at the communication skills required for challenging conversations in the workplace.

As a dental care professional, you play a vital role in ensuring a patient’s care is as safe and satisfying as possible. Part of that role requires you to undertake some difficult conversations. These conversations can be due to a variety of reasons, and not only involve patients but also their partners, parents and carers, and our colleagues in the practice team. This article will guide you through what we may consider a difficult conversation. 

What makes a conversation difficult?

What constitutes a difficult conversation? There is no hard and fast rule. We are all different and what I may consider a difficult conversation, my peers may find much easier. How we are feeling on a particular day may also interrupt our ability to face a more challenging conversation. A sleepless night, a troublesome journey to work or even feeling a little under the weather could all be reasons we may struggle to tackle a difficult conversation. 

Due to human nature, it will always be difficult to break bad news, even for the most experienced and skilled communicators. In dentistry, there are times when we regretfully must deliver bad news. There are four factors that can determine how difficult such a conversation may turn out to be.

Patient factors

Regardless of what role we play in the dental team, there are many different ‘patient factors’ that come into play during a conversation. Many patients have  a fear of the dental environment, which can understandably make communication tricky. Technical terms may hinder communication further and add confusion. 

There is also the possibility that English is not a patient’s first language, causing communication obstacles. Some cultural barriers can also exist when it comes to having a conversation with a patient, and it is important to take the time to understand any appropriate cultural needs as best you can, particularly if the culture is one you have not experienced before. 

Some communication issues relate to the patient themselves and can be due to their personality type. We must also consider how a patient’s previous experiences could influence their perception of you. 

Furthermore, some patients have such a strong personality that they are unable to let go of control and accept your advice. Some patients may come across as the opposite, unable to make a decision, and asking you as the dental healthcare professional to help them decide, attempting to pass all that responsibility on to you. 

System factors

As dental team members, we are all aware how noisy a practice can be; autoclaves whistling, doors slamming and receptionists on the telephone can make it a less than ideal environment for a difficult conversation. Any distraction will lead to ineffective communication. 

Effective discussions with patients not only reflect good patient care, but they also form an essential part of the consent process and should be accurately documented. Sadly, Dental Protection have heard from dental healthcare professionals who have been criticised by their employer/practice principals for taking up too much time talking to patients. 

Dental team

As dental healthcare professionals, we know the benefits a good dental practice team can bring, not only to patient care, but to our own wellbeing. It also allows the work we do to run smoothly. Conversely, working in a poorly functioning or toxic environment is destined to negatively impact our mindset and in turn, our ability to communicate.

Personal factors

At times it can be impossible to separate our private and professional lives, however hard we try. From time to time, the boundaries become blurred, and we lose focus. When we are dealing with personal stress, difficult conversations with patients can be even more challenging. Inevitably, stress will impact the way in which we all communicate, in turn exposing dental professionals to more patient complaints. It could be the slightest stress factor, such as a terrible journey to work or a disagreement with a relative that can negatively impact our communication style, not only with patients but our colleagues too. 

Mitigating difficult interactions

Both dental healthcare professionals and patients alike would prefer a private and comfortable space for a potentially difficult conversation. This space is best served as a non-clinical environment, to prevent any heightened anxiety for the patient and result in a better outcome. 

A critical component to consider is who will be present during the difficult conversation. It is best to be chaperoned when you are with a patient, preferably with a composed member of the dental team, who will support and not distract you. But what if the difficult conversation is with a colleague? It’s important to keep out of earshot of other staff members by locating an appropriate setting away from the practice. This can prevent any unwelcome complications of gossip and rumour mongering. This would be an unfair and disappointing development and, ultimately, would not achieve the desired outcome. 

Difficult conversations can be awkward and stressful. Feelings of stress can affect the way we absorb and react to information put to us. Therefore, we should choose to ‘respond’ rather than ‘react’. When we become stressed, a switch is flipped in our central nervous system, resulting in a ‘fight or flight’ reaction. While we can successfully converse in the ‘fight or flight’ response, it’s much easier when we remain cool, calm, and collected. Choosing to ‘respond’ and side-lining the ‘fight or flight’ reaction will inevitably result in a more amicable outcome.

When an unplanned difficult interaction occurs, we lose control of some of the elements of a ‘planned difficult interaction’. It’s vitally important that we do not lose control of ourselves and that we remain composed. The temptation to react should be kept in line as far as possible, to ensure we do not act in a way we would regret. It may seem trivial, but even taking deep breaths can help you to remain calm and keep a clear mind.  

Whoever may be in earshot of a difficult unplanned interaction will be judging you, your professionalism, and ultimately the way that you deal with this situation. We must also remember that there is always the chance you are being filmed on someone’s mobile phone. Regardless of the obvious breaches of the Data Protection Act, we all know that the video could be in the public domain in moments, and once it’s out there, it’s almost impossible to successfully retrieve it – something that none of us would want or hope for.

Consequences 

Professional

The professional consequence of a difficult interaction can be a complaint, and while many of these complaints will be made at local practice level, some will be escalated to the Irish Dental Council (IDC) and/or the Dental Complaints Service. The Dental Council’s new Code of Practice on ethical standards, entitled Professional Behaviour and Ethical Conduct, clearly sets out how we, as dental healthcare professionals, are expected to conduct ourselves. The IDC would take a dim view of those who do not behave in a way that maintains a patient’s confidence in the dental profession.  

Personal

Naturally, a difficult interaction can make us feel generally uneasy, and when it doesn’t go well, can make us feel unhappy about ourselves, the situation, and the outcome for the patient. Nevertheless, the consequence of these difficult interactions can have a cumulative effect and impede our ability to have healthy interactions with patients and colleagues, eventually seeping into our personal lives. 

In all, it’s far better to try to pre-empt difficult conversations in difficult situations, and manage them, and ourselves, as best we can.