How to Handle ‘Difficult’ Patients (Without the Emotional Trauma!) – PDP102

Jaz’ Introduction:
Hello, Protruserati, I’m Jaz Gulati and welcome to this or can I say it’s an awesome episode? Oh, my God Vy Phan will blow your mind. This is a real world topic. There are so many communication gems shared in this episode. And really, when it comes to communication skills, when do they really matter? I mean, yes, it’s good to get case acceptance and building value through user communication. But what really matters is so tough patients, those confrontations, those arguments that you might have with patients, you know the ones where your heart is racing? Words can really powerful. And I think communication skills are really tested in those tough scenarios. And we’re talking all about those in this episode. When it comes to the word difficult in difficult patients, I was really debating whether to use it or not. Because really difficult patients are just difficult people and yet difficult people in every walk of life. Like if you take an arbitrary figure, like 1 in 20 people, well, I don’t want to use the ‘A’ word. So 1 in 20 people are not nice people, right? And so 1 in 20 teachers will be not nice. 1 in 20 doctors will be not nice. 1 in 20 dentist were not nice, for example, right? So 1 in 20 of all your patients may not be the nicest people in the world. And so to deal with these patients, it can be tough. And these patients, we classify them as maybe difficult. But the funny thing about classing patients difficult is that what you might perceive as a difficult patient, your colleague, your associate, may find that they get along with a patient really well. And they think yeah, what do you mean, Mr. Smith is completely fine. What are you talking about? So it actually varies dentists to dentist and so our perceptions are equally important. When we decide who is “difficult”. There are lots of themes that we cover in this episode, like for example, patients who coerce you or bully you in doing into doing treatment that you don’t feel will work, patients who are rude, How to Write a dismissal letter to these patients and like what are the things that you should include in a letter like that. All the way to the end. If you listen all the way to the end, you will get Vy Phan talking about those patients who always always trying to twist your arm for discount, and how to handle objections like that. The Protrusive Dental Pearl I have for you is actually inspired by a conversation I had with Vy in this episode. This is something that was taught to me by Dr. Raj Ratan, who was my training program director during the f1. And he taught me never to say no to patients. Now, I know that sounds ridiculous, because actually, I’m saying we should say no to our patients. Because if someone’s being unreasonable, or you’re feeling bullied in treatment, or if it’s not in the patient’s best interest, then we should definitely be saying no, but what Raj meant by Don’t say no, is, let’s imagine a scenario where your patient wants to have some teeth straightening, maybe they want to have an aligner treatment, and you’d love to do that for them, but then neglecting their perio. And because of that reason, they’re not yet suitable for orthodontics. What you shouldn’t say is, No, we can’t do your orthodontics, because x, y and z. Patients just hearing the Word and seeing you as you say, No, it doesn’t leave a nice image. And they remember that. So why don’t we say in a different way? Why don’t we instead of saying No, you can’t have orthodontics because x, y and z? Why don’t you say I would love to do your orthodontics for you, I think we’ll get a great result, your bite will be better, your ability to clean your teeth will be better. I’m really looking forward to doing this to you, however, can you see and then you show the photos, can you see that your gums are looking a bit red, I want you to be proud of this result I want me to, I want us both to be proud of the result we’re going to get for you in the future. And so that we can get you a really nice result with the bells and whistles. We actually want your gums to be pink and healthy so that we’re ready to do this treatment for you. This is what we need to do first, we need to do some hygiene, we need to get you to some brushing, bloody bloody blah. And then we’re going to do your teeth straightening. How does that sound? Is that a much better way than to actually saying no, no, we have what have said to the patient is no, you can’t have it yet, because of your gums aren’t quite there yet. But pitching it and phrasing it a different way can be really powerful. Hope you enjoy that pearl. And hey, if you did, could do me a favor if you listen to Apple podcasts. And please do leave this show a rating but a new thing now, for my Spotify listeners. If you’re listening on Spotify, stop right now, go scroll up and give me a rating. I would really appreciate that because Spotify ratings are a new thing, and really helped my show to get discovered. So if you give me a rating, I would really appreciate that on Spotify as well. Anyway, I’ll stop blabbing and I’ll catch you in the outro

Main Interview:
[Jaz] Vy Phan, Welcome to the Protrusive Dental podcast. How are you?

[Vy]
I’m good. Thank you. Thank you so much for having me. It’s really exciting to actually finally be on one of the podcasts and listen to them for quite a while now. So thank you

[Jaz]
It’s so great to connect with you all the way from Melbourne and we’ve been exchanging emails and it’s been so great to have your listenership and your contribution now. So, I love getting people on who listen to podcast because I find that people who actively find something and tune in something they are connected in a way that you almost are like a self selective a bunch of people and what I find is that we are the geekiest dentist and this is a recurring theme. So I always love interviewing people who have actively listened to not just this podcast but all of the dental podcasts and stuff because I think it’s so much we can learn out there. So those people who don’t know you are Vy, tell us about your self, Vy. Where do you practice? What kind of interesting things which you told me about the email that you’ve done? And what we’ll be talking about today?

[Vy]
No, definitely. So my name is Vy, I’m from Melbourne. I actually do my university degree in Cannes, Far North Queensland. So James Cook University, I graduated 2016. I’m actually in private practice since then so sort of started running, imagined my own practice since I graduated. And now we’re fairly big team. So there’s about 6 dentists and our health therapist, we have three chairs running, and we open seven days. So fairly busy practice. And as you can imagine, post COVID, everyone’s coming in. But it’s really interesting, keeps me on my toes, and I do love it. But since then, I’ve actually got into a little bit of public sector work as well. And as I was telling you, and what really got me into this podcast was actually started listening to your podcast on the drive to the regional community clinics where I would teach fourth and fifth year dental students. So I drove to Ballarat, it’s an hour and a half. So your episodes actually worked really well, like about 52 minutes to an hour, and have a coffee. And you know, definitely such interesting topics. And it’s always changing to handle the different speakers. So I do a bit of teaching. And in Ballarat, I’ve also recently taken another teaching position. So one of the things that dentists at the Royal Dental Hospital in Melbourne, and there’s a dental teaching clinic in the dental hospital. So part of my role is sort of supporting the students and supervising demonstrators out there, and trying to create a better environment for the teaching clinic. So it’s really new to the role. And it’s super interesting to be able to say, I suppose the public and private facets of dentistry, as I told you, as well did a bit of extra studies after I graduated. So I recently completed my Masters of Health Medical law at Melbourne University. So [Jaz] Amazing [Vy] Thank you, thank you so much. It doesn’t mean that I can qualify as a lawyer or have you know, represent clients. But it means I have a special interest in medical legal, dental legal factors, I’ve got a bit of extra knowledge, it comes to that thing, it’s quite helpful in both private and public, I was lucky enough to be the president of the Melbourne Law Master’s Student Association when I was there. So that was a really great way to interact with different students, part of the university. And currently, I’m on the Australian Dental Association, oral health committee. And that’s mainly about promoting oral health, which I’m passionate about. So I do love dentistry. And I think for today as well, you know, having done my medical law masters, it is interesting to see things from a patient perspective.

[Jaz]
What I like to just extract the origin stories of people who come on, because some of the themes that cover is so relevant to young dentists listening. So one thing I just want to just uncover a little bit more on all the lovely things you said that is what inspired you to take your career trajectory, as someone who’s running a busy practice now as well, to also, I mean, the teaching bar I get, because I love that as well. But tell me about how you have now deviate a little bit towards the medical law side of things. What drew you to that aspect?

[Vy]
To be honest, if I hadn’t done dentistry, I would have done law. So I’d always had the interest in you know, I always been issues for me. But in year 12, or, you know, that’s when we finish high school to go on to do undergraduate studies. I actually got the privilege of working as a receptionist at a dental clinic. And I think that sort of took my interest out by being hands on and you know, I was assisting and the dentist that I worked for, he was super passionate about it. He’d make a filling be like a really cool thing coming like, oh, that’s the blue etch and the light cure and you know, for me being, you know, 17 year old, super excited. And I thought, you know, this is something I wanted to do. But I always wanted to do law, I loved reading, I found it really interesting. And so for me to be able to do something, and you know, when you’ve been a few years out, and you do all these CPDs you think, Well, can I do something that, you know, I’m really interested in? That’s a bit different. That’s a bit Dentistry related, but not really. So I thought, you know, take the plunge and do the law masters. And I did think maybe at some point I’d want be a lawyer and maybe I would do a law masters and see, but definitely getting a taste of that. I don’t think, you know, I would end up doing a JD or Bachelor Laws definitely not anytime soon. And I think I’m just going to take it back now and focusing on bit of the public sector work too.

[Jaz]
Great. Well, I think any dentist who’s thinking about in the next step in their career, it’s really good to have a level of self awareness like you had I think it’s a great thing to have, but figuring out you know, who you are, and what your interests are. And so you already knew about this potential law career that you could have had but you know, you got swayed by your appearances. But now you’re, it doesn’t mean that you can’t have aspects of that in your own life. So I love to marry those two together. And I think you said the message that for anyone listening is think back to before you applied in dental school, you might have had other interests, how can you now bring that in, to profession to keep that so that Fire alive in a different interest that you can have I think

[Vy]
Definitely. And I’m still lucky with dentistry, there’s a lot of flexibility in dentistry, you know, sometimes the hours we have, we have time to do part time studies. And there’s so much to dentistry like there’s such an artistic, my associate dentist, some of them are super artistic, you know, they’re doing pottery and things they like, I have a friend who pursued an acting career while being a dentist. And we have you know, that ability sometimes. So I was really privileged to be able to do something like this medical law masters and be able to sort of marry it, like you said, with dentistry.

[Jaz]
Well, today, I’m so excited to talk to you about a really, really crucial topic. This is something that’s gonna probably get people’s heartbeats racing, when they start thinking and recalling about certain patient interactions because it is about handling difficult patients. Now, if a regulator listened to this episode, I would like to say that all the themes covered in this podcast, all the scenarios are completely fictional. And this is for improving the profession and how we communicate with patients and how to get better rapport with patients. That’s the purpose of this episode. So any likeness to any patients who may listen to this, it’s completely fictional and coincidental. So I thought, you know, in movies, they have, it’s really cool to have that sort [Vy] Disclaimer [Jaz] Disclaimer as well. What a big topic, right? So handling, firstly, this this label, Vy, you know, I was when I was emailing I was reflecting afterwards, like, is it fair, that we label these patients as difficult patients because essentially, difficult in the perception of the dentist because one dentist might find the patient, very difficult, let’s say in quotation marks, whereas someone else might get along with them really well. So really, there’s something else going on? So the first question on opposes what are the challenges we face in terms of getting along with our patients in the view of especially the first five years because I can share some stories I’m sure you have as well, what are the big challenges young dentists face in terms of patient interactions, and communications, that makes us have this kind of conversation now about difficult patients?

[Vy]
Totally, the biggest things is comes to building rapport. And one of the first key things is gaining trust. So I find that the difficult patients we encounter, they come in straight off the bat through the door, Oh, I hate the dentist, you know, or the last dentist, he charged, rip me off for you know, always gave me so much pain, I’m so scared of the dentist, I really don’t want to be here. And it’s hard. As a young dentist, you might have had a long day yourself, receptions just booked in this toothache patient, you’re tired, you’re fatigued, you’ve had a complex case. And this patient walks in and tells you how much they hate you. And people don’t realize how tough it is, you know, for young dentists to deal with and you know, they come in upset. Now with these patients we have to think about is they’ve come in and they’ve most of them have had really bad experiences in the past. So they might be those patients that you know, they’ve been into with an older dentist or they whatever they say, maybe exaggerated or maybe completely true. So what’s really difficult is to be able to turn this patient around, completely change their perceptions of dentistry, gain their trust, make them like you again, and then still deliver a good clinical outcome. So it is really tricky. And I just want to say maybe, you know, a little note or a tip in these cases is, you know, if you really are trying to win these patients, so that you definitely needs to give them a completely different patient experience than what they’ve had before. And a unique patient experience because if you do, it really changes the perception and their outlook, and it’s tricky to do. But these patients who if they’ve genuine about, you know, how often the experiences are, it’s just the little things. Now, not every young dentist may have this no, not many at all. But you know, our dental chair is pink, and it has a massage in it. So that has a massage function. So a patient will come in, and you know, they’ll sit there and you know, for example, they say, oh, you know, I hate going for dentists, and I’ll just make a joke, keep it light hearted. And I think with these patients, you know, you really do need to do that. And I’ll just say, I bet your last dentist had never pink chair with a massage function. And you don’t need to have a massage chair, but whatever it is in the room or whatever it is that you’re doing, you know, and even scrub caps. Find something that’s a little bit different and just make it light hearted. Because do you see the expressions, their tone change when you do and I know, and I love your podcasts because you’re always, there’s a lot of jokes in them and you know, with the way you’re dealing with patients can be different. And I think with technology, what we have actually can make such a big difference. So something as simple as an intraoral camera. You know, I take and it’s not you know, you don’t have to get the whole kit and caboodle out which you can which is great. But if you want something quick intraoral camera, most chairs that have come with them now. Take little photos, even just your X rays that you put on the monitor in front of them. Some of these patients have never had a dentist go through and point out these things and it’s about interacting with them. I find the issues with gaining trust with patients is there’s a breakdown in communication somewhere. And it’s really easy to miscommunicate the patient, if you’re not interacting with them. If you’re talking at them, then you know, you don’t know how much they understand, you don’t know how interested or how involved they are. And when you interact with them, and you say, this is this cavity, actually what you really should say is you point to intraoral photo and say, what is that to you? What do you see? And then they think about it, they like, hold on, that’s Brown. That’s, you know, I think there’s a cavity, I think there’s a whole study, and they own the problem. And it’s no longer you know, Oh this dentist made me get 10 fillings, I don’t know why, it’s about, I need to go to the dentist, because I have these areas, this dentist show me and I know what they are. So it’s definitely making an experience. And it can be as simple as, you know, showing them these things. But I think one of the things gaining patient trust is patient education, there’s breakdown of communication often when the patients don’t trust you. And they’re not educated enough, because if they were, they wouldn’t hate going to the dentist because they know how important it is, they would value the visits, because they know it’s like going to a doctor, I need this. And patients just that wasn’t as opposed. They that didn’t come through to them. So I think gaining trust is really difficult. But there are definitely little things that we can do in order to help patients with that

[Jaz]
Trust is something that you gain in in tiny little drops. But when you lose it, you lose it in buckets , it’s one of those things. So it’s such a hard thing that we have to do. And you’re completely right, one of the key factors I found practice is the intraoral camera. And I think it’s just worth elaborating on that because a huge percentage, unfortunately, of a dentist, who ever listening right now, we’ll just never get around to getting their hands on intraoral camera. And like you said, it’s so widely available. So the one I usually recommend is like, it’s on Amazon, it’s like 150 pounds. So you know, as a for dollars or whatever. So inexpensive. Every time I drill into caries before I do will always take a pre op photo of that. As soon as I find the caries and I find the brown ADJ I will take a photo of that. And then once I’ve done the cavity prep, and I show the patient afterwards. And that is just amazing. Because you’re right, you have that patient that says, Oh, I don’t think I needed 15 fillings. It’s because the dentist never showed they’re working out. So something that we spoke about in communication before is show you’re working out. And I love it that you say that. It’s all about education.

[Vy]
Yeah, totally. And also show them the filling, like take a photo of the filling afterwards. And I like to put side by side, or as you do the stages they do before and then maybe in between. And in the final. And every filling even though you’re the adequate, they might have the best anatomy, it looks so much better. And patients are pretty wowed by it. Like you know, most patients and be honest see it and say look, they actually went in and did the filling like yes, they show me that needs to be done. But yeah, patients really appreciate it. And sometimes they you know, don’t know what they’re seeing went all the way back there. So it is really valuable. And look, it might be difficult if your clinic doesn’t have intraoral camera, but like you said it might USB once connected in, it seems that if you don’t have intraoral camera, you probably have the digital or a lot of I think even students I know habit, new go dentist, don’t use that type of camera. And if you know you really don’t have access to anything, you know, use the whiteboard, draw things out to patients, use the mirror, show them and I had them point out where you know, where are the cavities, show me, you can interact that way on also using your X rays. So there are definitely ways to, you know, educate patients.

[Jaz]
And just like you said, it’s about the co-diagnosis and getting them involved. You also mentioned about how when patients when they internalize the values, and that’s important, and you mentioned about doctors. Now one reflection I hadn’t. And sometimes I like to give my guests some questions advanced now this one’s a bit of a curveball I hope you don’t mind. But this is a higher level, I was really reflecting and I was thinking like if like the times I struggled the most with patients and thankfully doesn’t happen so much anymore is lack of rapport and the fact that patients personality type is so different to mine. So I mean it’s take taking one step back even further, I find that your patients will become a reflection of you. So if you’ve been practicing enough in one place, the patient’s come and the personality type of the patients that you attract and you retain are similar to you. So if you’re an introvert, quiet dentist, you’ll find that the quiet patients will come to you maybe and then if you’ve got the crazy patients at all my patients are crazy mad bonkers. And my nurses notice this oh hang on a minute your patients are like this. So your patients are a reflection of you. So if you’re getting poor quality patients that could be something down to the way you communicate and the image you project. So it’s important to A) be yourself and project your true self because otherwise, if you’re acting the whole time you’re not staying true to yourself, you’re being depressed and then you’ll find that you attract those patients. Now when I find a patient who I just don’t have that connection with. Here’s the dilemma now I’m gonna throw you, Vy, because when a cardiac surgeon has to see a patient, that patient may still be a difficult patient. But at the end of the day, they need this life saving surgery, right? And now you wouldn’t have a cardiac surgeon saying, No, I don’t like this patient, they’re difficult. I’m not going to treat them. It just wouldn’t happen. They need this life saving thing, right? Whereas in dentistry, one of the themes I want to cover with you Vy is, when do you think is acceptable? And then also, later on, we can cover about how do you tell the patient? Like, what kind of stuff do you write in a letter to say that actually, we’ve had a breakdown in relationship, we can’t continue. But then is it fair, that we do this to our patients when actually it’s healthcare? This is the higher level moral ground I’m coming here. So what can you, any thoughts that you have on this?

[Vy]
Yeah, totally, look, there are definitely cases where I think emergency cases and when I say emergency cases they’ve come in and they might not be the happiest patient. But if you can provide, you know, the provide safe treatment, for example, go to facial swelling, right, or, let’s say, Periodontal abscess, the tooth is not close to any, you know, difficult, you know, anatomical landmarks, you know, you can safely take it out, the patient’s, you know, not the happiest, not your type, not your cup of tea. But I think in emergency situations, you should always try and do the treatment, okay, if you can do it safely, if you know they need it, but it is really close to a sinus or whatever it is, then you should still consider referring whether, you know, do they need antibiotics, when you’re, whenever you’re not seeing the patient yourself or providing that treatment, you always need to make sure that they’ve got some referral pathway. And you’re not, you’re leaving out in the wind. So if there’s a patient that has emergency treatment, and let’s say they’re difficult patients, so you’re less likely to want to do a, you know, a procedure where that the higher risk, so I always say, right? I’ll call the, you know, the oral surgeon and say, Look, you know, I’ve got this, the patient has been, so I show the patient that I care, I can’t do this treatment for you. You know, it is, you know, I think that it’s a high risk situation, I want the safest and best possible outcome. Since I can’t do it for you, let me try my best to find someone who can. And they see me on the phone, and I talk them through it. And I say, look, he’s really busy. Just give me a moment. And they sense that and they think, Wow, this must be really serious, it must be really difficult that she’s going out of our way to call oral surgeon. And you know, I find that when they can see that you’ve done all these things, they’re less likely to care that you didn’t do it. You know, if I can’t get along to the private oral surgeon, sometimes I’ll call the reg at the local hospital, maxfacts reg, and just say, Hey, the Patient’s facial is swelling, or I just, you know, I write them a referral. And sometimes in some cases, when I know how bothered they are about something, and I couldn’t give something to them, I just don’t charge them the consult. And you know, and you’ve come all this way, usually I charge this fee. But you know, I’m sorry, I can’t do this for you. And usually when they see that they’re like, look, she wasted her time too or you know, and when sometimes patients do give you that they say, Look, I’ve come all this way, I’ve wasted my time. And I just nicely say, Look, this is your x ray, this is for you, you can take that, I’ll email it to you, you’ve got a copy. And I know it seems like a waste of time. But I think you’ve come out of this knowing your issue, what you need to do, I’m not going to charge you for the consult. And I’ve had patients take a step back and they say, You know what, no, I’m sorry, you’re right, I did get something out of it. Sometimes they sort of say things off the cuff. Now in non emergency situations, how you would deal with that is, you know, you deal with the emergency, or they’ve come in and they’re not in pain or whatsoever, then I feel like it’s warranted to you know, do your checkup, you know, come in for a checkup, what did you check up and clean. Most cases, I think something like that is fine. You come up with a comprehensive exam. And usually I sort of do like some multidisciplinary approach. So if it’s a patient, I don’t think maybe necessarily suitable for me. You know, there are specialists, so I give them options, sometimes the Perio I refer to different specialists, if I find there’s a certain type of patient, and because I’m such a big team, as well, I know a lot of us, we’re all sort of quirky and different personalities. And I think, look, this patient I think is going to gel better with my associate, they’re going to get along, they’ve got like, for example, when Alex you know, he likes computer games or video games, and like those patients, sometimes it’s hard for me to build rapport with them, you know. And you know, I get the crazy cat ladies, because you know, you might say to my cat on screen later. And I don’t know what you mean, there are patients you don’t gel with, but you might know someone who gels with them. And then there are cases where you might not be able to spin them off to someone. They might want to keep seeing. Those patients that you think you don’t actually gel with. They keep requesting you and they’ll come and sometimes

[Jaz]
AKA the HotSync patients.

[Vy]
You see the name in the books and you’re like, but I think with those patients, I keep it simple. I don’t do any complex work on them. Because I know for example, even if it’s endo or if it’s I have to come back. For example dentures. They’re not a good denture patient, you know, the ones that you look in, you know, and you know that they’re might even like the chip on outcome. Can I keep it really simple. So I might see that Every six months, if they’re not a patient that I feel like, they’re not someone that’s necessary rude, they just don’t, you know, they’re not your sort of cup of tea and your personal and so, you know, and I get sometimes, but oral health therapists might do the clean or the hygienists will do the clean, and I’ll come in bits and pieces. So they kind of work around that not everyone can necessarily be your cup of tea. And if you think about it, you know, we meet these people, you know, like, you’ll go to doctors will go to a maybe you know, a phone company or shop and you might sweep someone and they still you know, give you what you need. And they’re not the best person or that you didn’t get along with them. But you can still give this patient whatever it is that they want, if they want to keep coming back. But I think you should avoid doing a really complex treatment, or the ones where you go home at night, and you’re going to really have that weight on your shoulders. And if they’re completely unsuitable, like you said, Generally there’s, I feel some sort of maybe inappropriate, whether they’ve been really rude, or they’ve come in really late, I find it often not just the fact that you don’t sort of get along with or have a different personality clash, I find usually they maybe [Jaz] It’s more, it’s more than that. [Vy] Yeah, it’s usually more than that. Because I’ve had patients when you’re right, the introvert, the quiet ones, and I can’t ever will be chat with them. But they’re nice patients, there’s nothing wrong with them, they respect me. And that’s when they keep coming back. But then there’s patients that they still see you, but they’re rude about it, they’ll come in, and they’ll and that’s what makes it uncomfortable. Or they question your clinical judgment, there’s something else there. And those types of patients, they’re the trickiest one that, I find that the best way, if it really isn’t something that you can treat them, and then something that’s a little bit more like obvious, you know, it is about writing that letter, you know, you sometimes even have to offer and say, Look, these are the local practice around your area. And we really appreciate you putting that you know, in the letter, or whether you communicate verbally, and provide a written letter and say, we appreciate all the time spent here. But due to you know, breakdown in communication, or, you know, differing opinions and thoughts, and, you know, I can’t be the best person to provide the care. And I’ve heard of some dentists to just say that, you know, they’re Mr. Recall, whatever, they’re just too busy now in the books, then they just don’t have time to look at it. And that’s only a bit awkward and uncomfortable. Because sometimes they book online and this only so many things, you can say No, and sometimes it’s much easier to just say, Look, you know, and for me as well, since I do a lot of teaching, I do a lot of things, sometimes I’ll say the patient, Well it’s been great having you, I have a really big patient load. And I find that sometimes, you know, I really appreciate coming to see me. But when we communicate things you don’t, we’re not on the same page. And you know, and it doesn’t have to be because they disagreed with you, or there’s a big argument wherever. I think either I’m struggling to communicate this with you. And you know, I feel like I’m just as things are just not so getting through as much. Whereas I recognize those shit, or this dentist, you know, he could probably explain things better than I can. And patients don’t tend not to take it isn’t all honestly, it’s so awkward Jaz. But

[Jaz]
I think the approach that you’re gone for Vy is I think you’re alluding to the letter saying it’s not you. It’s me.

[Vy]
Yeah, totally. Or is it just we Yeah, like we’re not communicating well together. And yeah, and I think sometimes, you know, just, even though they stayed in writing, I mean, with some patients, if you tell them verbally, as well, and you document it in your notes, and you say, Look, you know, and put it in and then you know you I think legally, ideally, you probably should give them something, but I find you know, and that’s honestly I think that’s a gray area, that’s definitely not something that was touched on my medical law masters when it comes to really getting rid of, you know, difficult patients, if there’s not actual legal matter. But in private, you know, in the private sector, we are privily, we can pick and choose our patients in a sense, we are a business and you know, especially when it’s not urgent emergency outcomes, we do have that ability to not see a patient, as long as we’re giving them the right referral processes. And, you know, giving them the documentation so that they’re aware of it and you know, giving them their notes. So, yeah, I think at the end of the day, and also like, you know, with the health fund, sometimes I would tell a patient look, we’re not preferred providers, you know, how about trader, there’s, you know, other dentists that you save a bit more money out and just sort of adding little bits and pieces in it and I think, you know, patients, they get the idea.

[Jaz]
Well, I think you going out of your way to suggest not just that, hey, we’re not the best match for you, goodbye, but hey, we might not be the best match, but I think you still get really good care that’s appropriate for you from X, Y and Z. It there’s a different feeling towards that that okay, although they can’t help me they’ve signposted me to places that can help me so if you’re gonna be doing any kind of letter, and we’ll maybe we’ll make like a template or something but Vy I think that that is so true that you shouldn’t just say we’re not the best fit, it should be like a We’re not the best fit But these places are available so you’re not leaving them out in the lurch. But I like the way you answer this question, because firstly, I agree with all the points you made. And I like your risk based approach. And I’m completely with you on that, that if and you’re right, this is never just a fact that I didn’t have I had a personality clashes more than that they were also rude to my nurse, or they question my diagnosis and or they micromanage the way I’m going to treat them. So like I had a patient who there was a dentist, Shadow me and then the dentist comes it takes a little step closer. I’m aware had a pandemic stuff, but still further and now everyone’s got PPE on, that don’t come any closer, like, you know, like a rude way and that’s not nice. And then when I diagnose caries and communicate it, then they’re like, Okay, well, I don’t want LA and I would like an amalgam even though I haven’t placed amalgam in six years, and this micromanaging, dictating me, that’s where it’s never just one thing. It was like four or five little things. And then henceforth, when I email you back, say, Yes, this will make an amazing episode, because I’m going through this right now my head, and these are tough things to face as a dentist and add on to that we one thing that you kind of covered a little bit is that those dentists in the first five years and Vy you look so youthful and stuff like, you know, my wife had this old, she still gets this, she still gets IDs, she still gets ID for buying alcohol and stuff. Whereas I haven’t been ID since I was 16. Because of my facial hair, but like dentists were like, Oh, hey, are you experienced enough and when patients start doubting your expertise, based on what you look like, That is another layer of a breakdown and trust. So what advice would you give to dentists, young dentists, particularly who are youthful, youthful looking dentist, this very lucky dentists who age so gracefully, What advice can you give them when a patient questions, your level experience based on your age and stuff?

[Vy]
It’s difficult and honestly, question I’ve had and you know, my practice, actually really young practice and totally not You mean, look, I think for me, it made me feel easy, because I do cosmetic injections. So I’ll make a joke about that. And I’m like, Oh, well, you know, I do your muscle relaxer injections, anti wrinkle injections, fillers, don’t ask anymore, no, I’ll make jokes about that. Or I’ll say something really awkward, difficult ones, and they’re judging you. And they’re the same ones that say you’re a girl, don’t take a tooth out, like you can’t, you’re not strong enough, you know, those types of patients, and they look at you and they’re judging. And you know, you know, it can be, but I’ll say things like, you know, it’s rude to ask a woman her age, like, you know that and that’s, and sometimes, [Jaz] What a brilliant strategy. I love that [Vy] I kind of like I make a joke about it, sometimes I just like but it really depends on the type of patient we have. And some patients are a bit more serious, like the older patients, they’re not gonna appreciate, you know, they’ll not appreciate a joke. And, you know, I’ll say something like, you know, it’s a bit easier when you’ve had at least a few years, because you can sort of make it and be like, Look, I’ve been out for a couple of years. And or, you know, what I’d get my younger dentist say, is, you know what, you know, I’m a fairly fresh graduate, but I was lucky enough that I’ve actually come across these cases a fair bit, and especially the ones that, you know, we a lot of us went to James Cook. And, you know, we saw a lot up there. And I say, look, trust me, it is there’s stuff I hear that, you know, you’re never you know, you wouldn’t say up there. So there’s lots of stuff that I’ve seen that sort of thing. And I guess they just reassured because you know, you might be young, you might be a fresh graduate. But clearly you have some experience in these areas. And if it really is the point where they really there’s patients that won’t stop, they’ll say, when did you graduate, you know, and they won’t leave, you know, they won’t leave you to it. And look, you know, at that point, we can choose to be like, Look, you know, these patients, they just need to see a senior dentist, you need to refer them to someone more senior in the practice, because you can’t get to put up with this, you know that it’s going to be hard no matter how good your work is, it won’t be as good as whoever looks older than you. But sometimes you can say things like, you know, look, I only had, you know, a couple of years, we did this for five years, but I did three years of practical experience. And I was one of the fortunate ones that managed to get a couple of 100 extractions through my time. So it’s something I’m fairly comfortable with. And usually, you know, and sometimes it’s sad as long as you have to explain yourself that it you can do that. And you know, sometimes like I said, you can make a joke out of it, you sometimes can deflect it. And sometimes you can just refer them on to someone else. It’s really tricky. And I have an associate dentist that literally still looks like he came out of high school. And what sometimes patients make jokes about how young he is because we have a big sort of, you know, photo of all everyone staff. I’ll make a joke like yeah, he’s literally graduated high school yesterday, and now I just laugh about it. And they’ll think he’s probably older than you know, he’s clearly much older. So it’s just a bit light hearted patients come in with a question you sometimes they’re just a little bit agitated and anxious. And one funny thing I’ve had one time is with one of my dental assistants. I had a patient who said something like, you’re a girl, you know, don’t you know you’re not strong enough to take this tooth out. So I stood up, I may have been in a mood Jaz and I was like to the patient, Well, here’s my DA, he’s a guy, he’s a pretty strong guy, I’ll let him take the tooth out, and I’m just gonna go grab a coffee.

[Jaz]
I love that. I love that.

[Vy]
He’s really funny. As soon as all he’ll get on there, and he’ll walk, you know, you do it. And then you know, we just don’t have a laugh about the patient, like, No, I’m sorry, my bad.

[Jaz]
A fantastic story. I love how you did that. But what you also did is, and this will be very memorable. You know, when you say something funny people will remember this, and people will use these jokes. But what you’ve given us it is three or four tools, I was expecting such a brilliant answer. But you’ve got essentially, you’ve given tools that we can use. So it could be humor, it could be referral, it could be reassuring the patient cuz sometimes the patient is just scared, they’re just scared. And they just need that reassurance. And then when you just say that one sentence, like, Don’t worry, I’ve done this before. And that’s all I want to hear. And that’s all and that’s all it is. But then when the patient is being persistent, having the guts to stand up to them and refer them or to ooze confidence, I mean, I speak to you now, Vy, I love the way you communicate, I think you’re fantastic communicator. And I think it’s a confidence as well, it’s having just speaking with confidence, and patients love to see that. And like, really, they can smell it. So when you are anxious about that extraction, or when you are lacking experience, and you’re maybe not communicating confidently, because you’re not yet confident in that procedure, or in that type of scenario, yet, patients will sniff it. And maybe that’s the point to either get some mentorship and or refer that case, or just, you know, see the situation, be aware of the situation and use that as a learning curve going forward. I think,

[Vy]
Totally, you know, what else Jaz? It’s great to be confident in saying you can do something, but be confident when you say you can’t do something. So, you know, and, and I have had, you know, patients and you know, had students that have watched me observing, and I am fairly confident and I’ve been lucky enough to be like that since I think only child thinks since I graduated even. But I’m really confident when I say this is a really tricky case. Look at that root. Look at that sinus, look, I don’t think we you know, we should really be doing this. I think it’s a case for an oral surgeon. And when you constantly tell them how difficult it is, they’ll also really take it on board. So they don’t think oh, you know, she’s not doing it today. She’s saying no, to me, I have to go someone else. They think, Oh man, It must be really, really tricky. But if you stand there, like I’m being an, and think, Oh, we could give it a go. I’m not sure about this. Then they’re like, is it really that difficult? Or is it her or, you know, but if you really can’t do it, you commit to it and you fail, this is what you need, and I might not be an adult for you or this is beyond what a general dentist should do. And you really say that to them, you know, and love them my life? No, yeah, no brainer that that does. That sounds tricky. Yeah, of course.

[Jaz]
It’s communicating with conviction, just like you said, whether you can do it or you can’t do it. Just be clear in your communication with conviction, say with confidence, and that that is a great little pearl there as well. I love that. I’ve got so much to cover with you, Vy this is going really well. I’m really enjoying our chat. Let’s talk about the my way or the highway approach. So my background is that I’m at a stage now where I’m getting more selective my my patients and it’s going back to maybe 15 minutes ago, I mentioned that scenario about the cardiac surgeon, and ultimately just want to say to everyone and this is not to this is not to I guess underappreciate dentistry in any way. But it’s just teeth, guys. It’s just teeth. Okay? It’s just teeth, we’re not gonna, we’re not dealing with heart surgery, thankfully. And this is why the risk based approach that Vy said works. And remember that general dentist, I think most people listening a general dentist, we have the most difficult job in dentistry as general dentist. And let us appreciate that one of the best things about being a general dentist is being able to cherry pick, it’s okay to cherry pick it. If we didn’t cherry pick, we’d go insane. So it’s about knowing when to refer and wintry. And to remember that. But now I’ve come to a stage Vy where I’m very much like in not in all cases, like I give my patients the option stuff. And if they choose a reasonable option, then yeah, great, I’ll do it. But if my patients start micromanaging me, and making me feel uncomfortable in any way, I’m very much with that patient, listen, it’s my way or the highway. And I’m happy to communicate that confidently, it took me some years to get to this stage. So I’ve had some struggles and stuff and coming home and feeling like crap. Because of the communication struggles. We all go through that. But what do you think about this my way or the highway approach? And how can you do it in a way that’s not going to land you a negative Google review? Or land you in trouble?

[Vy]
Yeah. Look, I definitely think there’s a place my way or the highway. Exactly. Like you said, you know, and I think they’re places where is important is when you’re being pressured. Pressured or bullied into treatment. So you know, young dentist, you know, and especially when they’re saying just things like, you know, I want Invisalign, and they’ve got gum disease, you know, things like that. I just want straight teeth. I want white teeth, but they’ve got cavities everywhere. I think my way or the highway approach is really appropriate when it’s in the best interest of the patient, you know, you know that it would be different, it will be risky, you know, there’d be more long term

[Jaz]
Inappropriate, risky, just not the, it will land you in legal issues.

[Vy]
Exactly. And one, I just want to say it doesn’t matter if the patient signs a piece of paper or you document patient warned that they got, you know, they’ve got gum disease patient informed, patient persisted anyway, patient agrees, understands, it doesn’t matter what those what they write, and that they genuinely agreed at the time and the handler of the money, you are the professional, you’re the clinical expert, you do that treatment, you’re going to own it. And if something were to fail, it doesn’t matter, they will want your the professional with more knowledge expertise, and you should know better than to have done that. So it really, and even patients will say stuff like Oh, trust me just put the crown on, it’s been fine. And you know that there’s pathology on it. And he might have not been painful, like, just put on like, I love you, as a dentist, just go for it. But you know, down the track if something were to happen, you know, and they’re definitely not your friend when they’re in pain. Not no one’s your friend when you’ve caused them pain. And I think it’s a completely different situation. So I think

[Jaz]
Very quickly forget, don’t they? Vy, about the conversations that you had, or what they sign they very quickly forget when things go wrong.

[Vy]
Yes, they do. And honestly, even if they said to be honest, like I know, at the time, and it still doesn’t matter, because you should know better is the as so I guess Yeah, so I think my way or the highway is really important. You have to stick to guns, when you know that, you know, it’s the ethical thing to do. And I must say as well, though you do there is a way of doing it. And sometimes it can be difficult not to I guess be a bit too harsh. It’s about being firm, but I suppose not harsh or offensive. And it can be really difficult when they’re arguing with you, or you’ve been an hour explains on you know, when you spend some time now [Jaz] It’s a fine line, isn’t it? [Vy] It is and they come back and ask you the same question. So I can’t demand yours, one, you know, and you’ve gone through all the gum disease and the bone and the bleeding. And it’s really tricky. And I think you know, the best thing is, always listen to them. And don’t, I suppose speak that too long, because they don’t get the chance that I suppose ask questions or, you know, they, it’s too much information overload through through addressing each key point, have an open body language when you do this, because let’s say you’re trying to be patient, and you’ve got your arms crossed, you know, it’s a different situation, you’re leaning away from them, as opposed to, towards them and open and involving them, you know, and, and sometimes can make a bit light hearted, like, I really just don’t want you to fall out. That’s all it is, you know, or I take so much pride and show the passion I take so much pride in my work, you know, I just I couldn’t send off a treatment that I know is gonna fail. Couldn’t do that to you just couldn’t do that, too. You know, and you just I love and you really just sort of, you know, sort of empathy and you make it in a way that it’s my way the highway in the sense that, you know, it’s it’s for you. But I think one thing I really want to get emphasizes, we can be on my way the highway, but we can never ever take away patient autonomy. So even if you know what’s in the best interest of the patient, you still got to give them all the treatment options, they must make that decision, you don’t make it at any point. And you know, in most, you know, pretty much every general diagnosis, you don’t make that decision for the patient. You should never do that. And you know

[Jaz]
What it’s worth pointing out, Vy for the young dentist, lack of experience that okay, yes, we must discuss all the options, but it’s all the appropriate options which are suitable, that would fulfill the patient’s goals, and will be clinically appropriate as well. And so sometimes I find that when a patient comes in, and they say, I don’t want a denture I definitely don’t want a denture, and I need to do something right now. And then when I see the dentist letters, they say, Well, your options are do nothing a denture, and then they go the rest. Well, actually, no, that doesn’t that would they wouldn’t be appropriate. But I guess medical legally in the environment, and I see why they’re mentioning it, but remember to keep it appropriate for that case for your patient.

[Vy]
Yes, definitely. Yeah, I think it was one of the episodes as well, like how many, like 7-8 ways or something to fill So yeah, every possible thing. Yeah, of course, it has to be clinically relevant. And it was a medical legal case, if you’re offering silly, you know, sort of options or options that really aren’t clinically appropriate. You know, it’s not, it’s not great you want you know, it’s distinct, you know, in that type of legal setting. So yeah, so totally has to be clinically appropriate. But I think that the my way the highway, it would be pretty, I suppose inappropriately used if it was more of the highway, because that’s what I’m good at. And that’s the only option that you’re getting. So let’s say a patient, for example, we’ve been back to Design, they don’t offer fixed ortho, so every patient that comes to the door, in these lines, the best thing for you my way or the highway, take it or leave it. That would be pretty clinically inappropriate. It would be this is what I’m good at in my hands. You know, that’s my experience and clinical expertise. But it’s worth a second opinion because I don’t offer middle braces here. You know, and have the conversation with them whether they choose to take a second opinion or not. Sometimes I actually encourage them to Because in a medical legal setting, for example, if you’ve referred a patient with specialist or another, and they’ve come back to see you again, and you’ve gone ahead and done it, it’s a little bit different than if they’ve gone ahead. And it’s failed, because they are well aware that thought another opinion, and you said the best thing was, I always say, ideal option, you know, the orthodontist. Next one I can do this is within my expertise, but get a second opinion, and then they come back to you anyway. And it’s also that faith that trust. So it is, I suppose, well rounded in that sense, but definitely not my way or the highway because you don’t know how to do another treatment option. Or you don’t want to you don’t like dentures so that that patient gets the bridge. But it’s my way the highway, in the end, it’s more of an ethical thing. It’s what you’re comfortable with, you don’t want to be pressured. And you do it in a sensitive manner in an open manner. And sometimes it’s really hard to keep our cool, it can be especially we had a long day. But we do have to rise above it. As professionals, we are expected not to, you know, engage in arguments, unfortunately. And that’s the job you have to be patient about and you want to, but you just you know, that’s something that you chat over a podcast, or you call up a friend and talk about it’s not something that you do in the day. And it’s and it’s tricky. But yeah, I think that’s the best way to approach it.

[Jaz]
You mentioned those levels of consent, I guess. And it reminded me like with a patient if you only do Invisalign, and and that’s all you offer. I love that you highlight that. And we actually covered that in one episode, which I just remembered. And guys, you should listen to this, because I spoke with Mandeep Gosal, specialist orthodontist, and he spoke about that exact scenario via about the three levels of consent. So if you only just offer Invisalign, that’s like the worst level of consent, what he recommended was to say was that, okay, you can have Invisalign, you even if you don’t do it, you should know about fixed braces and talk about that. And then maybe if there’s a restorative option, there, like there is this restorative option, you can build up your teeth and stuff. Now you don’t tell them yet ideally, that you don’t do that yet. But you, you, you, you when they pay it, when the patient thinks, you know what, I quite like this idea. So great. I know exactly the right person for you, that is a really good way to do it. And just accepting the fact that you can’t be everything to everyone, you have your little micro niche. But just because you have that nice doesn’t mean that every patient, you know, if all you see is all you have is a hammer, everything looks like a nail, we’re definitely want to stay away from that time entry. And the other reflection I had, as you were saying, all those lovely things was in specifically, when you’re communicating with patients, we mentioned about having that difficult conversation about my way the highway and one thing I remembered is something that Raj Ratan seven or eight years ago, he taught me that don’t say no to patients, because patients remember you saying no. So when you said Vy to a patient that again, I want Invisalign, but then you’re like No, but that the gums unhealthy. A really, and you you actually do the same thing, because you mentioned it, the better way to say it was like, like, I would love to do this for you. So I would love to do Invisalign for you. But I want you to be have lovely gums, so that you get a fantastic was I want you to have a brilliant result from this. So that we can do this, we need to go for x y z process. So you’re not saying no, you can’t do Invisalign, you’re saying I would love to do Invisalign, once your gums are healthy. So it’s a different way to do it. So patients perceive that in a different way in a more positive light. And just like you said, in a sensitive manner. So I think all those little communication tips that we gain are so important. And that’s when your communication really gets challenged in those heated moments.

[Vy]
Yeah. And I haven’t actually since that podcast yet, so I really need to. It’s really good that you brought it up. Yeah, that’s really good. But yeah, and even when I say things went to root canal, or it’s a difficult case that I can’t do, or it’s a tooth that I think is needed oral surgeon, I would love to do it. But it’s in that tricky spot, and you bring it back to the patient as well. I would love to but you know, the gums and bones, it’s all the foundations, you know, your gums, the foundations of your teeth, and it’s just like, when you build a house, you need the foundations to be good. And yeah, so I think it’s, you know, analogies as well, instead of showing them like, you know, I would love to do this for you and putting the onus on them, you know, it’s not because

[Jaz]
One thing I do Vy is the way I make put the onus on a patient is when I’m saying that x ray of their banana shape root. And I’m very much emphasizing that your tooth is shaped banana and your gums. I like this. So that’s my little technique to really make it like that your and my eyes are like ‘your’ it works.

[Vy]
Yeah, it’s a shame that your root is right in the sinus. Like you know,

[Jaz]
How unlucky

[Vy]
Yeah, and then patients get that and be like, oh, and they’d like to see this very much or, you know, yeah, no, but it’s helpful and that’s exactly right. You put the onus on them as they start emphasis just be the eye contact.

[Jaz]
I have to say like the time there right now is like approaching 9pm and I love your energy. I don’t know how you’re bouncing must have had so much coffee today. I love it. Well, you’ve answered that the main questions and I guess I’m gonna go back to the letter because a big question I see on the dental forums all the time is like, Okay, I’ve had a breakdown in relationship and the patient, and I need to, I need some sort of letters of thinking that we’re going to make a little template letter just to help him run out there, and maybe a download or whatever. So you mentioned already about a few points in that letter and how to mention that it’s, you know, it’s not you, it’s me, it’s us the breakdown in relationship in total about offering alternatives. And I love that you mentioned that they actually care, or it might not be me, but here are, you know, I’m not gonna leave you out. And look, here are some places that you can go to, which I think would suit you really well. Or it might be an internal referral to your associate or whatever. Yeah, any other tips that you think would make a really good letter,

[Vy]
I actually had to write fairly. It wasn’t even a template. It was from a template, but it was a little bit tailored. And I think in some cases with these difficult ones, a one size fits all template may or may not work, but it could be some structure that you follow. And then it does have to be tailored because every patient particularly difficult, I remember this one. And I had my mentor helped me actually. And I had a mentor that I’ve worked with him. He’s actually 70. His name’s Harry Osen. And you know, he can help out one day a week. And he’s also helping with new grads out now. So it’s awesome. But I remember him writing something about Yellow Pages. Like I don’t know if you guys have, do you have

[Jaz]
Yeah, we have the yellow pages. Yeah.

[Vy]
But it’s like, they don’t ever use the yellow pages. Yellow Pages, like, go look at that.

[Jaz]
So year 1990

[Vy]
Remember, like, it’s a big book. But, you know, for us, we have like health engine. So there’s like locals that they can look up and use. So Google, I think tips would be don’t make it too long. And don’t make it emotional. Don’t also talk about any specific clinical things such as, and you should never do this in a Google review. By the way, if you’re answering a negative Google review, don’t say, but your tooth is. So you presented with this, that’s clinical [Jaz] Confidentiality breaches. [Vy] Yes. Yes. It’s not something that’s appropriate [Jaz] In the public forum. [Vy] Yeah, yes, public forum, or, you know, even in this personal letter, I think, keep it non emotional, and don’t have it too long. And keep it simple. So do such and such. And I think for those that don’t present often, like they FTA a few times, they don’t make it to the appointment, they’re a little bit ease that you can just say, you’ve missed this appointment, that appointment, due to the appointment scheduling, etc, you know, we’ve had to unfortunately, discharge you or, you know, you can no longer have you present back to these appointments, you know, we more than happy to put you on a waitlist for future reference. Otherwise, in the meantime, you know, you can see such and such or have a look, and thank you for, you know, the visits you’ve had, or wish you all the best, that sort of thing. So that’s possible, if they present at every appointment, and, you know, for whatever reason, then you might have to allude to it say, you know, thank you for your continued support of the US, unfortunately, due to, you know, a couple of many incidents and breakdown and communication. You know, we’ve realized that when unable to offer you the best care, and such that we think it’s best that you just continue the treatment here with us. So it’s very simple, like a paragraph, if not, and we recommend that you visit these area, you know, these look for these sort of clinics or, you know, go on these search engines. Sometimes what else I do is, you know, you can refer to a specialist, as well. And in some cases where, you know, specialist management and you write them referred to a specialist, and then can even have that chapter specialist beforehand, and say, Look, these are the issues and, you know, the specialist can sometimes chat to them, but it does make it a bit complex, because they’ll still come back to you for the checkup. And if that’s something you really really don’t want to do, then you will have to discharge them. But I did think keep it simple, keep it non emotional, don’t put any clinical things and don’t have them read it, you shouldn’t be something that makes them I suppose, angry upset when they read it, it just is plain and simple. Unable to continue the care with you and, you know, thank you for you know, whatever support you provide us, and then you just sort of sign it and put it there and just you just break down communication or we’re unable to offer the complex treatment that you may require. And I think yeah, keep it like, I don’t think there’s a hard and fast rule. And I think

[Jaz]
I think it’s good yeah, you mentioned to keep it concise and non emotional because your default thing to do is that as you’re typing this or your emotions, you’re you’re you’re remembering those conversations and you definitely don’t want to be in that state of mind. And so I think the antidote to that is to keep it as simple as plain English as possible. So that’s a great tip and I think we should all remember that. Hopefully, you know, we’re not gonna be doing too many of these letters is the odd time which is why I think you’re right in your to have an element of you can follow a structure and make sure you’ve got a checklist so you don’t forget to recommend other places and you don’t forget these little things, maybe a checklist to be more appropriate, but definitely don’t Well definitely do make it tailored to that individual person.

[Vy]
I’ve heard of some practices, standing by registered post. Like you Some patients pretending they didn’t receive these letters and they just turn up. And you know, it gets really awkward because then you know, then you give it to them in person. But I think emails you know, you can do since receipt for you know they’ve received it. Because sometimes patient come back and say, Look, I never got it, you didn’t discharge me, I need you to do this for me now. So the fact that they’ve you’ve got Send Receive, it gets to that point. And then just documenting and putting your notes. Look, I’ve unfortunately had a patient that persistent beyond the letter, you know, and it’s unfortunate, and I had to record further and you know, there was text, even SMS and as they tried to send the surgery, so I had to put that documented, I had emailed screenshotted it sad. And that’s it’s hard when they persevere beyond that point. But I think just record everything, keep it concise. And if they’re one of those patients that might say they didn’t receive it, then just make sure you do it in a way where, you know, they’ve got read receipts, or whatever it is,

[Jaz]
I didn’t even consider that. So that’s a really good point. I thought my question is, what if a patient was rude to receptionist, your nurse or or to you? Now, you said, Don’t make it too specific. But is that I mean, how do you now put in a letter that, hey, you’re rude, we don’t want you because you’re not, you know, this is we don’t accept rude behavior. But then without making them emotionally charged, because the person who’s rude, they never truly appreciate how rude they were. Right? It’s one of those things that you didn’t know, they might have been rude, but they’re like, No, you guys were just unreasonable, or you guys, whatever. So how do you think it’s worth mentioning about the rudeness? It’s a difficult one.

[Vy]
It’s a difficult one, sometimes it can be miscommunication or communication breakdown with team, you can make it just broadly, we have a sign. And I apparently, and this is more so actually more from, you know, hearing bits and pieces and what I was actually taught, but you should have a sign that says, you know, we don’t tolerate verbal or physical aggression, whatever, verbal zero tolerance, zero tolerance policy, exactly, you’ve got that on the wall. And you know, you can remove it off the premises. So you can verbalize verbal aggression, or, you know, you know, whatever to the team members, or, you know, the team members may have felt, you know, uncomfortable. And sometimes those conversations with those patients, it might mean that if, especially if they route around, but you you just had a conversation with them verbally first, because when you’re the clinician, and they’re nice to you, and everyone else, they don’t realize that, you know, that they like this. And you know, and then you just and you just say to them, Hey, you know, like and they just do nice to see you say hey, look such and such and, and I think if you say something like, I know the way you are sometimes you know it might you might be at work and you we have a bit of a laugh, but the front desk or they might not know you as well as I do. So let’s is it possible? And you have to have this conversation with them. And it requires quite a mature approach. But you know, it can you try and just be a bit more respectable consider it, because it is a team environment. And you know, I need them in, you know, to help me out to fit your appointments. And we all need to work as a team, you and mean and whoever. And I think it’d be really hard to get you in and book those appointments if we can’t work around with everyone. And when there’s a bit confronted with that, usually, they’ll probably be more considerate. And they’re less likely. Yeah, usually. Yeah, I find that if it’s abusive enough, but you usually doesn’t want necessarily a whole lot of them out. I think it just needs that one on one communication. And they usually caught out because they don’t realize that you know, and then then I think they turn it back especially they’re really like you. So I actually have had conversations with the patients because I get I you know, and being a practice owner, I obviously love my team. I don’t, you know, I hate it when patients are rude to them. Because they’re like my family too. And they’re the ones that stick it out for you. So I have that conversation with the patient. And usually I think when they realize

[Jaz]
That’s the test. That conversation is the test. So how they respond to that conversation will make your decision very easy as to okay, do they get the letter or Okay, they’ve got their, you know, their their wrist slapped, and they gonna behave now. So that’s good. But I guess it also depends on the level of aggression that was shown to a startup. Yeah, like, sometimes it’s so much that you know, that case not even worth having that conversation. And then yeah, that’s because it was so bad. But if it was like a small one, a bit of aggression, maybe they had a bad day. And but you know, that actually in the chair, they’re usually quite nice. And you want to give them a second chance to redeem themselves and into Yeah, but to also get the message that hey, you know what, you’ve done it once, but never again. So it’s important to get that message and I think you explained that really well. The you’ve answered my main questions. Thank you so much for wow, I mean, I really enjoyed our conversations. I think it’s gonna give a lot of value to young, inexperienced dentist, but how to manage these awkward situations. Anything else you want to mention at all, in terms of this theme of handling difficult patients?

[Vy]
I think we went through most of it. One of the things I just want to suggest I think we are maybe one things we didn’t mention it. It can be really difficult when maybe patients bring up financial issues, just as a younger dentist and his patient brings up and they say look, but I can’t afford that treatment. Or you know, can you make it a little bit cheaper for me? And then they start saying, you know, I’ve got this young kid, and it’s really, really sad. And I think that’s a difficult one is to low SES areas, which you may have listened to faces where I know my new grad sometimes had, you know, that odd patient that comes in. And with those type of patients, you know, what I would suggest saying is, you know, never be judgmental, and at any point, just listen to them and say, look, and until I understand it, and I say words, like it’s an investment, I know all these feelings, it’s a lot to take in. And yes, definitely a lot of money, in the long run is gonna be investment in eaten shoe. And if we really think about it, you know, it’s going to cost you a lot more in the future, if you don’t do it now. However, I see where you’re coming from, you know, your pose is different. I don’t know what you’re going through. And I’ll offer alternatives. Like we can’t compromise on our fees, because they’re reflective of, you know, the materials we use the time we put in, you know, but how about this payment plan option? How about this private health insurance? How do we break this up a little bit, so we’re only doing the worst ones you said, give it a money here and there, and really just working towards them. And I think when they see that you’re trying, like you can’t compromise on those fees. And it’s a good standard to have. Because once you discount them once, once you say, Okay, once you set the precedent, so you you really shouldn’t compromise on your fees, but you find little ways to show that you care, and that you understand that they might not be able to afford the treatment. I think sometimes patients just need that. And also the ones that they wanted, you know, just to get that extra, now discount, or whatever it is, they know that it’s not going to work again, that’s probably another thing that I think we call it a fair bit. And it was so interesting to chat with you about it, Jaz, thank you for having me.

[Jaz]
It was absolute pleasure. And I also respect the fact that just now even when you answered that financial situation or the explain that again, you follow that principle that I mentioned Raj, he didn’t quite say no to the patient, you said, Actually, we still love to help you. But how about these alternative ways that might suit you better. And that sentence you said about our fees are reflective of the materials we use and our time, like, everyone should like internalize that. I love that saying because sometimes when you’re presenting us scenarios, it’s sometimes good to know a couple of canned phrases that you already got to sometimes give you that thinking time to give you your more tailored response. So that was fantastic. I love that. Where can we follow you on Instagram? And you know, now that you got your medical law stuff in the background? Do you have a website where he connect with you?

[Vy]
Yeah, I’ll actually need updated photos on our website. But my practice is sunshine Family Dental. So our Instagram I think is sunshine family dental clinic. And my Instagram is just veewhyp so like they whip but it’s like vyp? So that’s my Instagram but yeah, you know, awesome just to see the practice, you know, we try and put little, we try and post you know, a couple of posts a week and each of the posts we have Instagram would be one about a staff or personal one, one that’s more like you know about all periodontal disease or have a picture of their ad or opening hours and then little quotes so yeah, so that’s definitely where you know you can connect with me or the clinic.

[Jaz]
Amazing. Thanks so much, Vy, for your time and for your conversations. I really enjoyed them and hope to catch you again one

[Vy]
Thank you so much. I’ll keep listening to a podcast if I have to listen to that one though. The ortho one

Jaz’ Outro
Well, there we have it guys. How good was Vy’s energy. I hope that this episode gave you some tools that you can use when your next encounter that “difficult patient.” This is last episode of 2021 so I’m wishing you a very happy new year as we ring in 2022. I really appreciate your listenership guys. Honestly it means a lot to me. Hope we grow together during 2022 to help you smash all our goals and look forward to learning together in 2022. If you wanted to give me a New Year’s gift, like a 2021 goodbye gift, then I would love for you to share this episode with a colleague who you think might find the theme of this episode. Very useful. Anyway, thank you so much. Once again.