Top Tips for Treating Nervous Patients

//Top Tips for Treating Nervous Patients
Top Tips for Treating Nervous Patients 2018-06-12T08:48:23+00:00

photo of Fraser Hendrie, BDS
by Fraser Hendrie BDS MFGDP

Top Tips for Treating Nervous Patients – PDF Version

Don’t get involved unless you really want to help…

Firstly I would say, please don’t look to treat nervous patients if it does not genuinely interest you. We all know that for every patient there is the right dentist somewhere. So if you are certain treating very nervous and phobic patients is not for you, please don’t read any further. Equally if you are looking for a few ideas of what has worked for me and my team over more years than we now care to count, please read on. The list is not meant to be exhaustive by any manner of means and is more a collection of thoughts.

Be on Time

This is a real old chestnut in dentistry, we all know that running exactly to time is exceedingly difficult but arriving for a first appointment and having to sit around for ages waiting is every nervous patient’s nightmare. So if possible set up your practice systems so that new patients coming to see you who are nervous are identified in advance and wherever possible offer a time slot where you are most likely to be on time. For example, the first appointment of the day, after a break or after lunch.

The Longest Walk

It is true that you only get one chance to make a good first impression. There are many ways of doing this including simply walking out to your waiting room, introducing yourself to your patient and making polite chat on the way to the surgery. At Craigentinny, our Nurses are very much part of the whole care process and act as advocates for their patients. So they will call the patient from the seating area, say Hi X my name is y and I will be looking after you today when you meet Dr Z. On the way to the surgery their nurse will make a little polite chat with the patient and quietly let them know that if there is anything that they need she is there for them. On entering the surgery, the patient’s nurse then introduces the dentist. This way the patient feels supported the whole way and hopefully does not feel so intimidated when walking into the surgery with the dentist for the first time.

Do we see what our patients see?

When you work in an environment every day you become blind to how it actually looks. So why not walk out of your surgery right now, clear your mind and walk back in again with curious eyes. What do you see? Is there a lot of clutter, scary dental stuff lying around? A nervous patient is quite likely to assume that everything that they see out on a worktop is for use on / with them. While this is not the case why not remove that doubt for them by clearing the work surfaces as far as you possibly can. Keeping trays on instruments out of line of sight is another important step.

Choices Choices

Give the patient as much control as possible, e. g. most patients will expect to be ushered straight into your chair, why not tell them they are welcome to choose whichever seat they feel most comfortable in. Most will choose the one in the corner of the room as far away from the dental chair as possible. But at least now the patient will have retreated to where they feel safest in the room, which is a great place to start your conversation. Wherever possible keep the conversation flowing with questions.

Big Ears

You really need to listen harder than ever before to the patient as they tell you their story, in it will be all the clues you need to help them, their fears, their triggers, and what things you need to find a way around to stop from scaring them half to death. By asking questions you are showing that you are interested in what the patient has to say and as such are more likely to act on it. Resist the temptation to jump in with solutions as they come to mind, just take notes and let the patient talk out all of their fears. After we are all talked out I usually ask if the patient feels up to letting me look at their teeth, if they prefer to be upright or lying back etc etc. By offering choices all they way you will build trust rapidly. We all know that it is almost impossible to do a thorough examination with a patient sitting upright, but if that is where someone feels able to start lets go. It is fine to be honest and explain to your patient that you can’t see everything as clearly as you would like with them sitting upright. But done nicely and positively it creates a basis of working towards the ideal situation where ultimately your patient will let you tip the chair back in the traditional manner. By reaching out and demonstrating that you are willing to respond to their needs and be flexible along the way, you will continue to build trust and confidence.

There Is A Control Freak in All of us

A few words about the “stop sign”, we all tell our patients about this but you absolutely must respond to it. If you are beavering away and your nurse spots even a waver of a finger, she needs to tell you to stop right away to check where your patient is at. Making sure you have chatted to your nurse to make it entirely clear that she is empowered to stop you at any point is critical, especially with newer team members. Be warned that if you fail to respond to the stop sign, then all trust will be instantly lost and you will have a very difficult treatment session.

It is worth mentioning that sometimes you have to just stop anyway. If you sense that the patient is in any kind of discomfort however mild, stop and remind them that it is ok to raise a hand at any time. Remember that some patients have fears or histories that prevent them from actually doing this even if you give them permission. So respond to a raised hand immediately but don’t rely on it.

Expectations

It is important to develop a basis on which you and your patient can work together. Right up front I think it is important to tell patients that if you work together in a spirit of mutual co-operation then it is highly likely that you will be able to help them. You must however manage their expectations that while you are a committed professional and will do anything in your power to help, it will not all be plain sailing. Explain in advance that there will be some visits where your patient feels that they have taken a huge step forwards and they may have other visits where they feel disappointed in themselves for not being able to make more progress. Remind them that any progress is good and that anything that you try together that does not work is still progress as you have identified something that they would prefer to avoid in future. Truth and honesty need to pervade every aspect of your working relationship, so before doing any treatment at all, it is important to manage expectations and explain that so long as you both agree that overall progress is being made, good and less good visits will be a part of it. A follow up call after a visit never does any harm either.

Attention Attention

Nervous patients need active care and attention 100% of the time. As the dentist you are dealing with what treatment you are doing for the patient, what materials you need etc and managing your patients emotional state too. Recognise that it is difficult to give 100% of your attention 100% of the time. Make it easy on yourself by making sure that everything is set up in advance and that your nurse is totally supportive and on board with helping nervous patients. Your nurse’s job is to support you and the patient throughout the process. If for any reason you need to take your focus away from the patient, your nurse seamlessly will take over. That way between the two of you someone always has 100% of their attention focussed on the patient and how they are doing. We train our team to look at things like how the patient is coping overall, how are they looking pale / florid , what is their breathing like, are they showing signs of a panic response, are their hands relaxed or tightly clenched etc etc.

Talk, Talk, Talk

Some patients like to know nothing about what you are doing, others want to know every little step. Either way you have got to talk, communication is at the very heart of helping the nervous patient relax and feel ok with the situation. Choose your words really carefully, reframe any part of the process that you know will stress them out. E. g. Anaesthetic is not injected, we simply let it soak in r—e—a—-l—l—y slowly – sounds a heck of a lot less threatening and if it is pain free then it will boost the patient’s confidence in your skills. If the patient does not want to know anything about the technicalities that is fine, but make sure you still chat to them throughout.

Don’t distract me!

Ok, actually why don’t you distract me just a little then. Music, video, chat whatever it is but preferably something that is inclusive and everyone in the room can participate in. A patient with a walkman turned up full blast is very isolated, in their own world where their imagination can run wild and can’t hear any of your soothing words. Why not hook their iPod up to your speakers and play their choice of music. It is important to provide guidance on this in advance, as it is known that even if they love heavy metal this will not lower their blood pressure or aid relaxation.

Frequent Breaks

Make frequent breaks part of your routine. Even if you don’t think the patient needs it, stop to offer a rinse, a chance to sit up and move around is always welcome. These offers help to convey your constant concern for the patients’ well-being and show that it is dentistry on their terms not yours. Even if it feels excessive your nervous patients will thank you.

Workflow management

Finally recognise that working with nervous patients who have recently joined your practice can be seriously hard work. But, like so many things in life, by giving first without expecting to receive, you will be pleasantly surprised when your early efforts are repaid. And if you help a patient overcome their fear you have a patient for life and someone who is very likely to tell their friends about your care.

It is critical that every nervous patient receives your very best efforts. Caring for this group of patients is, in my experience, massively rewarding as you see another human being overcome what was previously an insurmountable problem in their life. It is truly wonderful to see the personal growth that often follows when someone resolves a long standing dental fear.

Equally recognise that in helping, your clinical and communication skills will be tested to their limit. The early visits in particular can be emotionally draining for both patient and dentist. As such it is wise to try and manage your workflow to control the number of very anxious new patients that you are working with at any one time.

So there you have it, I hope you found something of value in the above article. Equally if you have ideas on how to do things better, please let me know as I would love to hear from you. I can be contacted at my practice on 0131 669 2114 or by e-mail Fraser [at] Craigentinny.co.uk

Craigentinny Dental Practice website: Dentist in Edinburgh – Dental Care for Nervous Patients

 

Comments

21 Comments

  1. Gordon Laurie 19th January 2011 at 7:45 pm - Reply

    Hi great article and very helpful. One little thing, I always think you should go and fetch a new patient in for yourself rather than getting your nurse to do it. You can learn an awful lot about them on that short walk down the corridor and they get a chance to meet you on neutral territory.

  2. Brit 10th March 2011 at 1:14 am - Reply

    Great article. What I have always liked is being reassured upfront ‘from the horse’s mouth’ about the next treatment appt…even if it’s only as basic as
    ‘it’s nothing to worry about, I’ll make sure you are numb’ or
    ‘it’s nothing to worry about..it’ll be just the same as today’ This really works, if you trust the person…because they have given their word, your anxiety lessens.

  3. Tom 12th April 2011 at 1:58 am - Reply

    I appreciate the “Talk, Talk, Talk” section. I was working with a patient today who had NEVER had any dental work done because she was scared. She is now an adult and needed to have a root canal done. I started out by telling her everything that I was doing, and what to expect. I think it helped build a relationship of trust.

    When she was done, she told me it wasn’t nearly as bad as she thought. I work with a lot of anxious patients, but this one was probably the most satisfying – I feel like together we are overcoming her fear of the dentist and I’m pretty sure she’ll be back.

  4. Swampscott dentist 20th April 2011 at 9:42 pm - Reply

    Fraser, this is quite a thorough guide to how prepare and deal with a nervous patient. Though you have addressed a generic nervous patient, in the specific instance he/she is a child, I would like to underscore one tip, which is that once a certain trust has been established, distractions can work well…Disney movies in particular are very effective, in my experience.

  5. Jenny pinder 25th April 2011 at 7:29 pm - Reply

    Excellent article .
    I emphasize to new patients that excellent pain control is something that is of the utmost importance to me.
    My nurse loves helping the patients and she sits in on the first interview. We advise the person that it’s so she can help, understand and support them. I introduce her and ask if they might prefer to speak to me alone. This will happen sometimes.
    She also goes through the treatment plan with them at the end of the appointment and makes sure they know what to do next .
    Often patients will tell her something important that they don’t feel able to say to me.

  6. Rob Endicott 9th May 2011 at 1:04 pm - Reply

    Great job with the article! This really should be required reading as so many patients need TLC and their fears taken seriously. Many thanks for writing down and sharing such great detail.

    All the best

    Rob

  7. Alana Merrythorogh 17th May 2011 at 9:15 pm - Reply

    Amazing article. I am a patient, not a dentist, and have dental phobia, and if my dentist actually did ALL of this that would help me a lot!

    • Tom 4th August 2011 at 11:28 pm - Reply

      Hi Alana – Just out of curiosity, can you point to one specific event that caused you to get dental phobia, or is it something you seem to have always had?

      Just trying to understand better the causes of dental phobia. Thanks!

  8. Lily 25th July 2011 at 3:24 pm - Reply

    I’m a patient. After three decades of going to the dentist with only minimal problems I have had some bad experiences in the last couple of years that leave me astonished at the heartlessness, greed and self-interest within the dental profession. I can’t begin to tell you how much I mistrust dentists now.

    Ii I had my way all dentists would have to do the following:

    * attend training in interpersonal skills that emphasises effective, empathetic listening
    * explore how best to address the innately unbalanced power dynamics within the treatment situation
    * undertake anti-discriminatory training
    * watch out for “groupthink” tendencies to see fellow professionals as always well-intentioned and unhappy patients/customers as “the problem”
    * regularly seek out and utilise comprehensive customer feedback (feedback forms are a great way to get truthful information about your patients’ experiences and what your staff team need to improve upon … patient focus groups are another possibility… just make sure the option to be anonymous is provided if you want the whole truth)

  9. Paul L Caputo, DDS 12th August 2011 at 11:17 pm - Reply

    Great advice. All dentists can learn by just listening to our patients.

  10. CDA Karli 13th August 2011 at 12:56 pm - Reply

    This was a great article. I myself already do most of what the article talks about. I deeply care about how my patients feel. My problem is getting other people in my office to do the same. I think a good way to start is having them read this article, and others like it. if any of you feel that not everyone is on the same page at your dental office maybe you can try this.

  11. Chris Reid 11th September 2011 at 11:18 am - Reply

    Hi. Im an Ex Para in the UK who collapsed outside the dentists front door on my way for a first visit. Taken away in an ambulance my GP told me, “we all have our fears, If you threatened to throw me out of a plane even with a parachute I would probably go nuts kicking and screaming and certainly would not get in the plane”. His advice, “take your time and fine a dentist you are comfortable with”.
    For all you Dentists out there, I now have a dentist I am sticking with. I am still terrified in the chair but I trust my dentist and he accepts that and works with me.
    So my fellow phobics when you are ready to, take that first step. The world of dentistry has changed.
    Fantastic article.

  12. Denise 8th October 2011 at 9:59 pm - Reply

    Thank you for your information and help with the issue of “Dental phobia’s” I am a Dental asst and office manager and have been treating many patients lately with this problem. Your site has helped greatly.

  13. Fraser Hendrie 2nd November 2011 at 8:45 pm - Reply

    Thanks for the feeback on the article as well as the additional suggestions. Dentistry is a broad church and there are so many ways that we can do things better to help our patients. Jenny, you are absolutely right regarding pain control, only by delivering comfortable, pain free dentistry time after time can you slowly unseat the fears that past bad experiences have created.

    Good patient experiences really are dependent on having a great dental nurse working with you. By being attentive, chatty and participating fully with our patients while carrying out the technical work of nursing they can make or break an appointment. I am blessed to work with a team of superstars who manage to make this this multi tasking look effortless. It is remarkable how often patients will choose to confide something relevant to their care to their dental nurse.

  14. Fraser Hendrie 2nd November 2011 at 8:46 pm - Reply

    Thanks for the feeback on the article as well as the additional suggestions. Dentistry is a broad church and there are so many ways that we can do things better to help our patients. Jenny, you are absolutely right regarding pain control, only by delivering comfortable, pain free dentistry time after time can you slowly unseat the fears that past bad experiences have created.

    Good patient experiences really are dependent on having a great dental nurse working with you. By being attentive, chatty and participating fully with patients while carrying out the technical work of nursing they can make a huge difference to an appointment. I am blessed to work with a team of superstars who manage to make this this multi tasking look effortless. It is remarkable how often patients will choose to confide something relevant to their care to their dental nurse as a result.

  15. Julie 3rd February 2012 at 5:26 am - Reply

    As a patient, conversely under the talk talk talk section I would want to know precisely why something is being done without the paternalism.

    Today I had an awful experience where I was told after the anaesthetic failed in the lower jaw that the additional injection was for my gums. Past experience with that part of my mouth says otherwise. The truth along with a bit of humility can go a long way for a patient like me (who loves science, medicine and the in and outs of how her body works) who has a really hard time trusting someone with a dental instrument in their hands. Especially one I have just met.

    Btw, the good dentists allow me to guide them on my terms rather than presuming to know what make me more comfortable. For instance, I appreciate it more if I’m told I can dictate when breaks are taken rather than having them done unilaterally. Sometimes I prefer when we can get the worst of it over at quickly as possible.

    And on that note I especially want to thank you all for some information I found on this site. I’m now armed with some knowledge I didn’t have before. That area of my mouth has always been nearly impossible to anaesthetize and over the years an accumulation of bad experiences made me phobic instead of merely avoidant.

  16. Stephen Murray 19th February 2012 at 1:50 am - Reply

    Thanks for putting this list up. I think I relate to the paragraph about listening most – that’s what I have been adjusting myself to do most recently, and although it’s subtle, I do notice results. Not only in my patients’ reactions, but also it makes ME feel more confident when I am talking to them, because it concentrates in my mind what they need/want to hear.

    Stephen
    That Friendly Orthodontist
    http://thatfriendlyorthodontist.com

  17. Dr Philip Jacobs 22nd February 2012 at 6:14 am - Reply

    Great article! Many patients have a needle phobia, so I think the best invention ever for a lot of nervous patients is The Wand. We have recently acquired The Wand STA, replacing one of my original Wand units. The STA is even better than the original, as it allows you to make one tooth only numb, avoiding the whole face and lip being numb for hours after an injection. My tip is to embrace this new technology to make the dental treatment experience so much more comfortable. Most people don’t feel a thing when you give an injection using the wand, plus it looks a lot less threatening than a syringe.

  18. Ann 24th February 2012 at 5:44 pm - Reply

    I wish all dentists would read and put this into practice. You should have seen the office I went to yesterday. The dentist was nice, but her place was a dump and she tried to get me to book s surgery for 5 wisdom teeth removals ( yes, apprently i have 5).

    Theres no way Im going back to her.

  19. Dr Roudy Matar 25th February 2012 at 1:45 pm - Reply

    great article

  20. kay 10th March 2012 at 11:54 am - Reply

    Was good reading this article, I’ve had dental phobia ever since I saw a bad dentist who put me in a lot of pain and told me to be quiet, I haven’t seen a dentist for years, I need a lot of teeth removing and denture repair but I’m too embarrassed to see one now and I can’t find a sedation clinic in Sheffield, but having a dentist who puts you at ease by having a laugh with you or talking is the way to go, pity none of my dentists were like that

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