Dental Nurse

Debbie Dibble, nurse (with a combined receptionist and practice manager's role) at the Grosvenor Orthodontic Clinic, Beckenham Kent

'Recently we had a patient who had not been to the practice for four months turn up and want to be seen there and then. He had not been to his last appointment and with orthodontic treatment you have to attend regularly or the appliance will not work. I made sure he saw the orthodontist so he was not in discomfort but he will have to come back for a longer appointment. If someone is in the wrong I am not one to give in but I calm the situation down. I smile and I am very pleasant and it's much harder for people to be nasty.'

Therapist

Credit: Maureen Moodie

Maureen Moodie, therapist at a community clinic in Glasgow where she treats patients with learning and physical difficulties or phobias.

A positive attitude is very important because the patient is only as confident as the operator

'I manage my patients by putting them in control. For instance, I will always explain everything I am going to do in advance and I will always stop treatment if they put their hand up. I also take the focus away from the treatment by asking them to visualise something else, such as what they will be doing after the appointment. For patients who have a gagging or anxiety problem, I start by doing everything to a count of three. Gradually they build up confidence because they know that I will always stop when I get to three. A positive attitude is very important because the patient is only as confident as the operator.'

Practice Manager

Carroll Beard, practice manager at Dr Ewa Rozwadowska's Dental Practice, Stroud, Gloucestershire

'So - how do you deal with 'difficult patients'? You take the sting out of their tail. You ask them what they would like as an outcome, and try your utmost to accommodate them, ensuring that you both maintain your dignity. We have found that people are pleasantly surprised when you give them the opportunity to air any concerns, genuinely listen, and try to help. A quiet confidential chat with any member of the dental team in a private consultation room usually resolves the most sensitive of situations, earns both parties mutual respect, and keeps the blood pressure at a normal level. Life's difficult enough, without making more stress for yourself and your practice.'

Technician

Credit: Chris Howe

Chris Howe, technician and laboratory owner, Howe Ceramics

We have an evaluation sheet so dentists can feed back their comments and things don't fester

'Relationships are built around communication and if that breaks down, the relationship fails and you lose a client. So I like to be able to talk to my clients - especially with treatment planning. I also like to be able to ring up clients and tell them they have sent me a rubbish impression or for them to ring me and tell me when something is wrong. We have an evaluation sheet so dentists can feed back their comments to us and things don't fester. There have been one or two occasions where I have rung up a dentist who has been difficult and politely said I don't think we are able to provide what you are looking for. Sometimes they come back and say can we work together and then we try again.'

Hygenist

Ged Durkin, hygienist at Holt Dental Practice, Norfolk

'A tip for managing sceptical patients: I collect newspaper or magazine articles which I can give to patients to back up any discussion. One arrogant patient with advancing periodontitis would not follow repeated basic advice on how he needed to clean his mouth. When asked why, he quoted a professor from a newspaper saying that 'two minutes of oral care a day was enough for him'. I pulled out that article and also an article showing the professor had not been fully quoted and confirming I had given appropriate advice. Since then he has been compliant!'

Receptionist

Allie Maas, receptionist/nurse at an inner city practice providing 100 per cent NHS care in the Midlands

'There are signs up in our practice saying that aggressive behaviour won't be tolerated and asking people to be patient when delays occur. Our policy is to keep patients informed when there are delays because it is understandable when they get irritated. All the same, we still get patients who become very difficult. Often they are rude to me and the other nurse who works on reception, but change their tone when they go through to the dentist. But then there are some who are completely out of order and there have been times when we have had to call the police. Once we had someone who was drunk and who did not like it when the dentist said he would not treat him. Fortunately the dentist is supportive and he has deregistered some patients who have been consistently offensive.' (Name changed)

* See page 52 for our article on tackling harassment

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