When a patient presents with a mouthful of major dental problems but is reluctant to accept treatment, what can you do to encourage case acceptance? You can co-diagnose and cajole. You can soft-pedal and sugarcoat and offer to phase and stage. You can empathize and sympathize. While you try to educate, the patient chooses to ruminate and procrastinate. Your team can trot out a low cost loan and still be met with a moan. When the patient leaves with no appointment, you can shake your head, roll your eyes, and throw up your hands, but you cannot foist a choice on a patient.
Here’s a solution that many young dentists are timid about using but that most experienced dentists have learned to employ: speak plainly; tell it like it is. Patients come to your office because you are a licensed professional, an expert in dentistry. They may not like what you have to say, but at some level they want what they are paying for—your professional opinion. Just as you have an ethical obligation to diagnose, you also have an duty to provide patients with the unvarnished truth.
When the diagnosis is alarmingly clear and serious, the consequences of no treatment are that a bad situation will only get worse. Informed consent means that patients must be made aware ahead of time of the risks of treatment, but they also need to know—and you should document your discussion in their chart—the consequences to their health of their decision to ignore your advice.
It is of course important that dentists continue the tradition of speaking to patients in a calm, professional, and respectful tone and showing compassion for the patient’s dental issues. However, part of the trust that develops between doctor and patient is an underlying foundation of honesty.
You can begin a difficult conversation by using these introductory phrases:
In my professional opinion . . .
I have an obligation to tell you that delaying treatment is not advisable because . . .
I know this is not what you want to hear, but as your dentist I feel that it is important to be completely honest with you . . .
I wish I had better news, but your treatment needs are urgent because . . .
These comments can be tempered by telling patients that with proper professional care (and the patient’s cooperation by demonstrating conscientious home care), dental problems can be significantly alleviated.
The bottom line is that you have the ability to improve case acceptance and greatly help patients with major dental needs, but the patient must first face the reality of those needs if case acceptance is going to happen.
It all starts with telling it like it is.