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How to handle noncompliant patients and protect your license

Nov. 17, 2021
Don't be intimidated by noncompliant patients—sometimes a new approach is all they need. Here's what's worked for Amber Auger, MPH, RDH, when it comes to the stubborn ones.

I’ve been practicing dental hygiene for 11 years. During that time, I’ve inherited many patients who were deemed noncompliant. Clinicians did their best to describe these patients’ strong wishes not to have x-rays, and they scanned the signed documents stating these patients refused films. I actually love working with noncompliant patients because I love the challenge. I’ve developed a formula that anyone can use to increase case acceptance no matter the patient’s age, socioeconomic status, or zip code. Let’s dive in.

New face, new approach

When I’m working with a patient I haven’t seen before, I pretend I haven’t read their note. Mind-blowing, I know. I find that when a patient hears something for the second time with a different provider, sometimes is clicks differently with them. They need to hear the same thing without all the resistance behind the recommendation. If you start the conversation with, “I understand you refused this full-mouth series last time, but . . .” the patient is reminded how they felt about something before. Instead, I say, “Hello! It’s so lovely to work with you today. We haven’t worked together before; my name is Amber. Are there any concerns you have regarding your dental health?” I update any medical history and review the patient’s chief concerns.

Then I say, “I took a look at your history, and it appears that you need a full set of x-rays today. We typically recommend this every three to five years and it’s been eight since your last one, therefore it is imperative that we take the images today. This will allow us to see the roots of the teeth, the sinus, all bone levels, and have a full comprehensive picture of your dental health.” I assume the patient is going to say yes. If they say, “I’m going to skip the x-rays today,” I respond with, “Unfortunately, I cannot treat you without the radiographs. It’s unethical for me to do so and it’s has been eight years since your last x-rays. I’m not comfortable treating you without them. The dentist has asked me to capture these images today to evaluate the roots of the teeth, interproximal areas, sinus, bone levels, and to identify any abnormal lesions. We need these images to be able to evaluate your overall dental health.” I’ve never had a patient leave my chair after I explained this way. This could be an office where I’m temping, consulting, or even that’s become my new dental home.

Dentist won't confront patients who refuse x-rays
Noncompliant patients: Not all patients share the same motivation about dental care

Confidence is key

I recently treated a patient who is the CEO of a company. During morning huddle, the team warned me that he was rude. He was going to try to rush the appointment and text over my head the entire time. When he arrived, he sat down in the chair and typed furiously on his cell phone. I patiently waited, making eye contact the whole time. This lasted about five minutes. He finally looked up and said, “Oh, have you been waiting for me?” I replied “Yes, I’ve been waiting for you. I’m ready to start your treatment. Have you completed your email so we can focus on your oral health?”

I’ll never forget his grin. He put his phone on the counter. His note reported that he was noncompliant and diabetic. After providing my clinical assessment, I found moderate gingivitis throughout with heavy bleeding. I sat him up and asked him what he does for fun. He looked at me like I had seven heads. I informed him that I wanted him to enjoy his life more. His average 15-hour workday was not conducive to balanced A1c levels.

“I’m concerned about your oral and overall health,” I told him. “You have heavy bleeding in your gums, which tells me your body is trying to fight this inflammation. I’m going to show you how to implement a Waterpik at home. Additionally, I want you to use xylitol mints throughout the day and change your toothpaste. I want you to be happy and healthy so that gorgeous black lab of yours can have you in his life forever.” I saw this patient three months later. There was no bleeding, and all the 4 mm pockets had changed to 3 mms. When he sat down, he placed his phone on the counter and looked me in the eye and said, “Thank you for holding me accountable. I scheduled a vacation, and I’ve been home to walk the dog every night. You changed my life, not just my gums.” This is why I practice clinical hygiene, that moment right there.

Fearful patients

Patient objections are often linked to fear. They fear that the procedure will be painful, that it will be costly, and that the treatment will take many appointments and cause them to lose work time. When we identify any objections that patients have, we can give them the information they need to say yes. We can show them all the details of the treatment and reduce their fears. We can only do this through motivational interviewing. Asking open questions that will allow us to collect the data everyone needs for patients to commit to treatment.

Many clinicians are concerned they’ll offend a patient, or that a patient will leave the practice if we’re too strict with our recommendations. We’re either creating urgency or compliancy with our patients. We must educate them on their level of disease and allow them to decide what they want to do with that information.