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Have you ever had a discussion with a patient, only to find that their interpretation of the conversation is completely different to yours?
Even as a skilled communicator, there will be occasions in which the message you believe you delivered differs vastly from the message received.
There could be many reasons for this – some related to you, some from your surroundings and some seated with the patient. Truthfully, are you always giving your undivided attention? Are you really listening or is your mind wandering across your perpetual to-do list, your worries, your woes, or places that you would rather be? Loose language and hurried explanations have landed many a practitioner in hot water when they find the patient didn’t actually understand the meaning of a risk, and therefore had not actually given valid consent.
If your environment is noisy and bustling with incessant distractions, can your patient actually listen and understand you? Attention and concentration are finite resources, and you also need to hold firmly in your mind that many patients often do not bring the best version of themselves to the practice due to anxiety and fear. When we are fearful, we are hardwired to shut off higher level thinking to allow our amygdala to drive the bus. The consequence of this is a decrease in our ability to learn new things as we are instead primed to respond to danger. Add distractions and overly complex or inherently lazy explanations into the mix and we have a recipe for disaster.
Truth, in many ways, could be considered a rigid and fixed concept, as surely, there is only one truth? This belief is founded in the concept that truth is linked to fact. The issue however is that every individual’s perception of fact differs depending on many variables. What they have experienced, what they believe they have experienced and critically, what they want to believe they have experienced (sometimes occurring ‘after the fact’ and through the lens of strong emotions). Is truth then a rigid and immovable object, or elastic like a rubber band? If it is elastic how far can the band be stretched before it snaps, and do we as clinicians ever get stung by the recoil?
Perspective is everything when it comes to forming a point of view. In some instances, a patient can believe they have been harmed by treatment despite all evidence to the contrary. This is termed a perceived injurious experience (PIE). Perceived injurious experiences can quickly transform into a grievance where the patient not only believes you have harmed them but will move to verbalise this in a ‘name and shame’ manner – this has been aptly termed as ‘naming, blaming and shaming’.
Frequently, these misguided beliefs can cause the patient for whom you have tried your absolute hardest, to turn on you. All of your efforts, kindness, and attempts to go the extra mile count for nothing and rebound to hit you squarely in the face.
Remember, you will never win an argument with a patient. If a patient has already formed a strong view that they have been wronged, they are unlikely to take your word that they were not. In these situations, the involvement of an independent third party is often the only way to influence the patients’ point of view.
Sometimes it doesn’t serve us to face the truth, either because the truth hurts or because it doesn’t get us what we want. On these occasions individuals may cling to their own version of events, even while knowing this may be dishonest. More often, people will lie to themselves, as admitting they are wrong is a push too far.
As a clinician, listening to a complaint which is a flagrant lie can be incredibly challenging, but remember it is often far more nuanced than that. So, what can we do to protect ourselves from others who approach the facts with a flexible view of the truth?
As proceduralists, we are highly skilled at documenting the treatment we perform. Equally, we are often more casual than we ought to be at documenting the discussions we have with the patient – if there is a difference in truth, it usually lies within what was said rather than what was done. The unpopular but rigid truth (especially in legal claims) is that the only true way to evidence what was discussed is through your clinical records, so time needs to be taken to consider how these discussions can be captured well. If you are unsure, Dental Protection has resources that can help.
There is often a window of opportunity where a patient can be bought back on side, but it does involve actively listening to what they have to say even if you don’t agree. Do not be concerned that by letting someone air their grievance is in some way agreeing with their point of view. We all like our feelings to be validated, particularly when we are emotional, and it is not unreasonable to afford your patients this respect. Using active listening skills to help a patient feel they are understood is critical in successfully navigating your way through difficult conversations.
People are entitled to their opinions, even if they don’t align with ours. While it can feel hurtful when someone doesn’t agree with our perspective or actively opposes it, becoming upset only causes you more stress and worry. It will be challenging, but try not to take this personally. Remaining angry resolves nothing.
Regretfully, occasions can and do occur where the person stretching the truth is in fact the clinician. This is very, very dangerous.
As professionals, we are held to a higher standard than our patients with fundamental responsibilities such as a duty of candour, the obligation of open disclosure, and the requirement to be deemed a ‘fit a proper person’ suitable to hold registration. Stretching the truth, whether that be in the information we give patients, the documentation we keep or the items we claim is not something we can do as the consequences to our reputation and registration can be severe.
So, while the truth may indeed be an elastic construct, dependent on one’s perspective and beliefs, as registered professionals, the elasticity of truth is not something we can afford to put to the test.
