PATIENT MANAGEMENT - Delivering bad news

Patients and parents often react negatively to hearing what they consider bad news.  It may be the need for extractions, or the advantage of uncovering a gingivally impacted tooth, or the risk of decalcifications due to poor brushing.

Here are three suggestions to make these types of discussions more persuasive and better accepted.

Suggestion #1: When delivering bad news, always complete the sentence with the SPECIFIC BENEFIT TO THE PATIENT.

For example:

Extractions for treatment

• Rather than: “We need to extract four teeth in order to straighten her teeth.” (Patient often reacts poorly)
• Say instead: “What we do in situations like this is to take out a tooth in each corner of the mouth to relieve the crowding and eliminate the overbite.” (Bad news, specific benefit)

The phrase “What we do in situations like this” also conveys that this procedure is common and implies that it’s the “standard of care” not only in this office but elsewhere among all orthodontists.

Laser exposure of gingivally impacted canine

• Rather than: “We can uncover this tooth so that we can bond a bracket on the tooth.”
• Say instead: “We can open up “a small window in the gum” so that we can bond a bracket on the tooth which will speed up treatment and probably get you out of braces 3-6 months earlier.” (Bad news, specific benefit)

Suggestion #2:  When discussing poor cooperation with parents, get the parents “off the hook” for their child’s behavior:

1. Greet parent and child with a smile – it sends a non-verbal signal to the parent that this will not be a “difficult” conversation

 2. Get the parent “off the hook” – most parents feel that they are in some way responsible for their child’s behavior so they will either assure you that they have been doing everything possible (so you won’t blame them) or blame the child (so you know who’s at fault).

So that the parent knows you’re not blaming them, turn to the parent and say:

 “This conversation is not about you.  I just wanted you to hear what I’ve been telling Bobby so you’re aware of the situation. I know that you can’t follow him around all day reminding him to wear his rubber bands.  It’s up to him to remember.”

• Then give the bad news as you “align” with the parent
  • “She’s not wearing his rubber bands as we had hoped . . .”
  • Translation: “Hey Mom, we’re on the same side here.”

• Give a sincere compliment
  • “I appreciate that he’s been honest with me about not wearing the rubber bands.”
  • “That allows us to have a good discussion about this.”

• Convey the patient's promise to do better
  • “He’s told me that he is committed to wearing them all the time.”

3. If the parent doubts that the child will do better next month, “align” with patient. That is, be on the patient’s side.  The patient may cooperate only to prove their parent wrong.

• “He has promised me, and I believe that he will.” or
• “I think he can do it. He’s told me that he is committed, and I believe him.”
• If the parent continues to doubt, still express confidence in the patient.  We have nothing to lose by supporting the patient.  It places us at odds with the parents, but in an adolescent’s eyes, that’s a good thing.

4. Finally, never scold the patient – there’s nothing that will demotivate an adolescent more than being reprimanded in front of one of his parents.

Suggestion #3:  To be more persuasive in delivering undesirable news, use “If you do …, if you don’t.”

Example: Poor Brushing

• Rather than: “If you don’t start brushing better, you’ll end up with marks on your teeth when the braces come off.”
• Say instead: “If you do focus on keeping your teeth clean from now on, you can prevent any permanent white spots on your teeth. But if you don’t, there’s a good chance you’ll be disappointed when the braces come off because everyone will see the marks on your teeth when you smile.”

Express the negative consequences in terms of the patient’s felt emotions.  That’s something that is meaningful to them.

Example: Extraction of primary tooth to reorient an ectopic canine.

• Rather than: “We need to extract a baby tooth to free up the permanent tooth which is out of position.
• Say instead: “If we do allow your dentist wiggle that baby tooth out, then there’s a good chance that the permanent tooth will come in naturally. But if we don’t, there’s a possibility that the permanent tooth may become trapped which will require surgery later to open up the gum so we can attach a bracket to it.”

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Sometimes saying something a little differently can often make a big difference!