Mastermind - Episode 19 - Safety and Conflict Resolution

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Join host Lisa Newburger, LISW-S, as she and Rick Adelstein, DDS, discuss conflict resolution and safety in the dental practice, in this month's episode of the Dental Mastermind Series. [20 Minutes]


Video Transcription:

Lisa Newburger: Have you ever found that in a dental practice people, patients, sometimes your colleagues, your subordinates, are dealing with anxiety and frustration, and it is becoming an unpleasant situation at times? We had an applicant for a position a dental assistant recently, at one of the practices that I worked for, who reached out Clyde, when he applied, I called him. And he said to me that he had already called the office and had already scheduled an interview with the Office leader.

You know, I touch base with them, everything's good, they went ahead with the interview, they get back to me and say, you know, Lisa, this isn't the right person for our practice. He came across a little bit aggressive, and they were uncomfortable and didn't think he'd be a good member of the team. So, I pleasantly call and let people know that they're not moving forward, and another candidate is being moved forward. And think that's the end of it.

This applicant has now applied 10 times. And it's getting to a point where we're concerned for safety. You know, in a lot of these dental practices, it's predominately female. And if he is a sort of enough to bypass usual methods and come to the office, what happens if he shows up? And, you know, that was one of the issues that I brought up with the practice is how exactly are you dealing with security? How are you dealing with an angry patient, or in this case, an angry applicant or employee that you've may have had to let go?

So, the conversation today that I'd love to have with Rick, is the whole issue about it. Are there security plans? Or is there anything in the office in a dental practice that has been set up to address issues like this?

In your experience, Rick, is there anything that you have been trained or your practice is set up? If you would get a very angry or hostile patient? Or in this case, it was an applicant to come and join that practice?

Rick Adelstein: Honestly, no.

I've never, like had a conversation with any of my, you know, colleagues and the three study clubs I'm in, we've never had this conversation, I think it's a great one to have. I think just the way that I am, I hate confrontation. I really tried to defuse things, even if it means just giving everything the patient wants if anyone were to get upset.

I think, you know, most dentists really try to stand behind the work they do. So, speaking for patients first, and then staff. Second, I think that no one likes for the most part coming to the dentist, it's never the most pleasant experience. There are many other places They'd rather go. So, they we understand that it's not a place where people are going to feel like happy about being, so we've been trained to, to try to make them feel at ease as much as possible.

And even for the extreme patients that are, you know, much more outspoken about their, their negative feelings about being there. We really just give in to everything and tell them that you know that we're going to do everything we can to make it as painless and pleasant as possible. And even though they say they hate being there, you know, we just tried to make them feel better when they leave than when they came in. But even that being said, my biggest fear is for an angry patient that you know, for whatever reason, someone that maybe didn't come in with pain and then left like after the anesthetic wore off and they're in pain. Just my fear is a patient coming in just coming at me and wanting to hurt me and It's never happened yet. I hope it never does. But that is my fear.

Because I just think that people just dislike coming to the dentist so much. But yet we've never addressed it. So, I think that that's a good thing to, you know, to kind of talk about. And then as far as staff, I mean, we really haven't had any angry staff just leave and, and, you know, I think the first thing that that angry staff will do is they'll call either OSHA or the Dental Board. And that probably is more hurtful and harmful to practices than anyone coming in trying to, like threaten us physically. Because, you know, and I think nowadays, the Dental Board knows, you're probably aware of, of disgruntled staff that leave, and they try to really like to vet the calls are getting before they start coming in and making any accusations.

But, you know, we don't have any protocols in place. I mean, our building doesn't have security, per se, but there's a maintenance person. And there's other offices that could help. I guess, if there was an issue, if we were free, like a single office where there was no one around, I guess, our only our only thing that we could do would be to just call 911.

But by the time they got there, it could be late. So, I wish I had a better answer. I just it's never a conversation I've had with other with other dentists about that situation.

LN: But it's an honest answer. And I do believe, and I don't remember how many months ago, there was an incident, not a dentist office. But it was, I believe, maybe orthopedic surgery, it was a patient who had had back pain who came in with a weapon, I don't recollect the details. But it is something that unfortunately, in this day and age with the things that we're facing, there needs to be some kind of instruction for that front office person, you know, because when you think about if an if a patient is irate if they are coming from the outside, versus if they're in a chair, that that receptionist is the first line, to know, I think you'll bring a really good point which is listening and being empathic.

Because when you have someone who's dealing with pain, or is really angry about something, one of the feelings, or one of the things they may say is on how no one's listening to me, and no one is hearing what I'm saying. And sometimes being able to give someone the chance to vent to disclose everything that is upsetting them, because now you have something to work with, as to what can be done.

RA: Absolutely

LN: I think that's a really good point. I think, for employees, they also need to know at what point do you go and get your supervisor? You know, a lot of times when people get upset, myself included, if I get upset at something, and I feel like I'm not making progress. I am like, can I talk to your supervisor. So sometimes even if it's another person who's coming, again, that person may be feeling like they are being heard, and that they're getting somewhere.

But your point is well taken as far as you know, the fear that something could happen.

And I don't think staff are trained, you know, but I think times are changing a little bit. And I think it is something people need to take a look at. So, well. If something was happening in your office, let's say with one of the dental hygienists and a patient with getting agitated or raising their voice. What would the normal way to try to address it?

RA: So as soon as it was brought to my attention whether I could hear it because our office is not that large that we could you hear what's going on, you hear the other staff working, I would leave my patient and then come in and just try to you know, help. I wouldn't accuse anyone of anything, I would just stand there and wait and see how the hygienist was, you know, was handling it. And if she looked at me and I and I thought she needed some help, then I would come in and I think the problem is that we are more attuned to sticking up sticking up for the patient.

And our motto is a customer's always right. So, our staff sometimes resents us a little bit when patients are angry on the phone. And it's you know, most of time about a bill or something but they'll call and they'll be angry and then they'll say something and then we'll go to the defense of the patient before our staff but if a patient was threatening the staff or doing something in the office, then we would of course be there to defend our staff and we would come in and just try to defuse it and help you know the staff and then if the patient was just really being unruly, we'll just dismiss them you know, then and not necessary. Just not from the practice, but to dismiss them from their appointment, and then follow up and see what we could do but, but they know that we would always be there and that they always have a safe working environment, and we wouldn't put them in harm's way. And if there's anything that happened, we would get in there before, like, we asked questions, if they felt unsafe, we were coming in and help them.

But just to kind of go back on what you said about being empathic, empathetic, I think it's so important for us to listen, and they don't teach you that in dental school, because there are patients that come in and then had been to other offices, and they feel like no one's listening to them. And they just want someone to listen. And really, like think about what they're saying and not act like they're crazy, because we all have certain ailments and pain. And many times, it's not easily diagnosed. And even if we can't diagnose it immediately, it's listening to them, it's paying attention to everything they're saying, and not dismissing them is really like being crazy.

But you know, we have to really believe what they're saying, and try to help them. And if we can't, it's important to find a specialist that can and just really be attentive to what they're saying, because many times, they feel like no one is listening to them. And they do feel like, we think they're crazy. And then in return, they almost think they're crazy when they really aren't. So, I think that's like so important. And sometimes if it means listening for 30 or 45 minutes, you're not getting anything done with a visit, but listen to them and taking notes, and just documenting everything that they're saying. So that we can really help them or find someone that can help them. I think that's so important.

LN: So, you know what I love that you said represent, you said that you would come into the room, and you would be standing in the back and kind of following the cues of that dental hygienist or that staff person who's in the middle of it. And, you know, I just think that that sounds like such a great way to handle it.

Because you're right, there are different personalities who would just come in and take over the situation. And the reality is your hygienist may be, you know, effectively handling it. But your kind of assessing the situation by coming in to see what's going on and seeing you know how you can assist. So, I just I really liked that because, you know, different people have different styles of leadership. And you know, that's the kind of a leader that I would want to work for as far as in a dental practice or outside of. But I think, though, in looking at, you know, what are other things people can do? When a situation escalates, you brought up a really good point about documentation twofold.

One is that, you know, we're hearing the story or making sure we're taking it down correctly, so that if we have to go to the dentist or whomever to fill them in, we have the correct information. But also, it's a paper trail. And it's something that will protect the hygienist as well as the practice. And to keep that in mind as well. I do think also, when people have gone through a situation where a patient has escalated, and it's been very unpleasant. Sometimes that staff person when it's resolved, maybe they need to take a 15-minute break, or just to decompress from all of this before coming out working on my math, I would want them to take that break. So that and I think you also pointed out if it does escalate, and it can't be handled, you know, to call 911.

And to let you know, if someone is not leaving the practice, and it's they need to leave the office is, you know, they're threatening, or they've done something, you know, for people to feel comfortable to call 911 to make sure that they are safe or that they feel safe in that, you know, trying to keep the patient safe as well as for them.

Not easy things for people to wrap their arms around and think it's a dental practice. Why would I possibly have to think about security issues? Right, right. You know, the other side is, and I really haven't thought of a dental practice as a place if I was drug addicted as too well, you might have something and I might come to your office, hypothetically, of course. But I come to your office looking for drugs. And you know, it does. There are so many types of things that can occur that, you know, for some practices, they lock that door between the waiting room, and you know, the back area where you're taking them to the rooms, just as one more step. Those are usually not the thickest of doors, but it's just something as another barrier. But have you ever had an incident where things look like they might

I'd be escalating maybe even with, maybe it wasn't employees, but perhaps, where a patient was getting agitated that it might go south.

RA: No, I, in all my years of practicing over 25 years, I've not experienced that. But, you know, it's interesting, because, you know, dental office used to be used to be targets of break ins, because we were, we were known to have drugs. And I think this kind of what, what precipitated the opioid epidemic, which is obviously a different topic. But years ago, when I first started practicing, the drug reps would come in and give us samples.

So, all the dental offices, even, especially the surgeons would get dozens of samples of prescription narcotics, very addictive narcotics, we keep them in our office. And when patients had procedures, we'd give them, you know, a box of like, you know, six or whatever, just start them off, and then we give him a prescription, but we'd always keep them in the office. And we've had a couple of breaks in attempts years ago, that we could tell, and, by the way, the door was trying to the door was damaged, but no one actually got in. And, you know, since probably the last 10 years, you know, the reps have never given, you know, they're not giving away any samples anymore, because of what's been going on, which is probably for the best. But we were targets now, you know, the only thing they can break in and get is either, you know, computer equipment or, you know, instruments that they could sell, but they want to drug, and you know, that was a big thing back then it's it. Luckily, it's not happening anymore.

LN: But it is an interesting thing. I mean, we've gone through this challenging time with the pandemic, and COVID. And then mental health issues, you know, when up, people weren't going to a dentist for a period of time, and they may have myself included had more complications from dental issues, because of the shutdown and how treatments were going. And it seems to me society as a whole seems to be a little bit more wound tighter than it is.

And people are their frustration tolerance. I mean, I remember a man who was angry that there was a delay, to buy a soda pop at a drugstore, then instead of just going buying it from a machine outdoors, just that frustration and tolerance. And I know that a lot of times going to the dentist, if you have anxiety issues or pain issues that you know, kind of can be compounding with just current events and how life is going right now.

RA: Yeah, it is. Your last thing I like to say about it is with patients that haven't come in, in the last two years because of the pandemic. It's not to blame them and not to, like make it their fault. I mean, they know it is I think we’re; you know, we have to just really explain to them that we understand that they weren't comfortable coming in, and not to make a situation where they might have more things going on. Because of that, you know, don't blame them just say you know, from we can only move forward, we understand you haven't been able to come in, but from now on, let's see what we can do to make things better. And it's so easy to blame a person and to place blame on things. And as long as we make them feel like it's not their fault. And make it seem you know, when they get cavities. They're all upset, we feel bad about it. But it's not you know, even though technically, I guess you can't blame anyone but them. It's just a matter of how you respond and how you act, and let them know that it isn't their fault, even if it is just to move forward and try to help them if that makes sense.

LN: Yeah, no, I think it's very wise. I think a lot of times, you know, people don't realize that their body language shares something judgmental, or how you're looking or how you're standing or closed off. You know that when things like this happen, and people escalate, you know, to be aware that there's other patients, the doctor, your boss might be overhearing as well. So, there's just so many different variables. But in closing, my challenge to you, Rick, is to next time you're in one of the dental study groups, take this topic to them. Absolutely. I do think that at some point, unfortunately, security may be an issue for a dental practice. And my feelings are always better to be prepared ahead of time than to be like, that was a waste of time, but at least we have a plan. You're right. No, you're absolutely right. That's a great thing to talk about. Okay. Well, thank you for joining me tonight, and I look forward to seeing you next month.

RA: Thank you. Take care. Bye. Bye.