Confrontational Tolerance

Asking difficult questions, even if it is the last thing you want to do

When patients enter a dental office, they may have a guard up before they even walk in. Hopefully, your team has developed a strong rapport with the new patient, inquired about their “why” for seeking treatment, and begun to form a positive relationship with them.

Even if all of those boxes are checked, you may still have to have difficult conversations with yourself and the patient. How do you cope in the face of those awkward conversations? Are you capable of navigating the choppy waters? Or do you succumb to pressure?

What is Confrontational Tolerance?

When it comes to being a patient advocate and helping them get what they want, confrontational tolerance is a valuable tool to have in your toolbox. It is the ability to ask difficult questions proactively, even if you are afraid the patient will not want to hear them.

Why Do We Struggle With Confrontation?

People may have fears or tendencies to avoid confrontation for a variety of reasons. Perhaps they’ve had a bad experience in the past, or perhaps they’re extremely introverted and the prospect of asking questions outside of their comfort zone is intimidating – maybe they think it just feels downright yucky. Fear of confrontation is frequently based on false assumptions. Remember that confrontation does not have to be a bad thing if it is done effectively and with good intentions.

Remember, as a team member in the practice, you speak dental – we often refer to it as a second language. For those who aren’t exposed to it on a regular basis, it can be very confusing. As a patient advocate, it is your responsibility to use your knowledge of the dental language to help patients understand all of their options and get what they want.

If you let assumptions about what the patient will or will not want get in your way, you won’t be able to enter discovery mode and learn what the patient truly wants. Always double-check your assumptions!

Common assumptions in the dental practice:

• They won’t accept the comprehensive treatment plan.
• They’re going to want a partial over an implant because it’s less expensive.
• The patient won’t want to schedule their appointment at that time.
• They’re not going to answer if I call them.
• They won’t want to move forward with treatment because the tooth isn’t hurting yet.

While some of these may be true, depending on the patient, how can your office’s team members help to further educate the patient and emphasize the importance of completing treatment? It’s up to the office to help paint the value of why the patient should proceed with treatment. If case acceptance is struggling, it might be time to evaluate what this process looks like for your team.

Tips and Tricks for Confrontation

We all know it’s going to happen, right? We’ll have to have a difficult conversation with a patient (or perhaps even a coworker) at some point. How can we prepare for these situations and navigate them with as much confidence as possible?

• Be prepared. 
  • Make use of all available resources. If you believe you will need to speak to someone, prepare ahead of time and be well-versed in order to speak confidently. You know your stuff when it comes to dentistry!
• Don’t sugar-coat it.
  • While this does not give you permission to ever be rude to patients, it does mean that you don’t have to put a positive spin on everything. Most patients will value candid honesty from another human being.
• Don’t take things personally.
  • Remember, this isn’t about you. Dentistry can be extremely emotional for some patients, whether due to cost, fear, or lack of trust. If they become emotional during these conversations, be empathetic and offer assistance where you can. Your responsibility is to the patient – not for the patient.
• Know your limits.
  • You know yourself better than anyone else. What makes your blood boil and what makes you thrive in conversation? If you believe a conversation is heading in the wrong direction, prepare some redirect statements or excuse yourself for a moment to “ask the doctor a question”. Use this time to get some water, take some deep breaths, or ask the doctor a question if necessary!
• Have social awareness.
  • Be aware of both your emotions as well as the patient’s during these discussions. If negative emotions are being expressed, take a breather and consider what you can do to help. Maintain a positive attitude, be respectful, and acknowledge their feelings.
• Keep in mind the purpose of confrontational tolerance.
  • The goal is to be tolerant of other people’s forms of confrontation, not to introduce your own. When necessary, check your attitude and avoid being combative. When patients put up barriers, it’s easy to say, “OK, let us know if you decide to proceed with treatment. Have a nice day.” This is not an effective way to advocate for patients.
• Give people the benefit of the doubt.
  • Many people, whether they realize it or not, have unconscious bias. This could include assuming that a patient will not schedule an appointment because they have state healthcare, or that a patient will refuse treatment because it is expensive. Present the patient with all options without bias and allow them to make their own decisions. You’re there to educate and assist them in obtaining what they desire, not to make assumptions for them.
• Ask for the commitment.
  • If you’re hesitant to ask the patient to buy in, they’ll be hesitant to buy in! Openly and directly request their commitment.
• Prepare to ask, and ask, and ask again….
  • It may take up to five attempts to gain a patient’s commitment to treatment. If you give up after the first attempt, you will undoubtedly fail to win their trust and business. Don’t give up!

Common Examples for Patient Objections

1. This is too expensive.
   • Price is all about perceived value, so avoid this objection by shifting the focus away from cost and toward the value the office can provide. Less really is more. Pay attention to the patient, acknowledge their pricing concern, and investigate it.
     • “You know Susan, I really appreciate you saying that. Can you tell me a little bit about why you feel that way?”
2. I need to think about it.
   • Avoid this objection by establishing enough value in the treatment and truly understanding their decision-making process.
     • “Tell me, how do you expect to make such a decision? What are the most important considerations you’ll have?”
3. I need to run this by my significant other.
   • This should have been discovered during the discovery process when determining the patient’s “why.” At this point, you should know whether or not another decision-maker will be included in the consultation. It is acceptable for patients to want someone else to be involved in this process!
     • “Help me understand, how do you typically make a decision like this?”
     • “I totally understand; what are you going to be considering as most important when discussing this with your husband/wife?”
     • “Let’s get them on the phone or here in the office so I can help relay information as best as possible.”
4. I can’t afford it.
   • If you’re hearing this and it surprises you, it’s because you didn’t ask questions during discovery to determine if the patient has a dental budget in mind for their treatment. This should have been determined earlier in the process. You can bounce back from this by having prepared statements ready to go – don’t use them as scripting!
     • “I completely understand, I might feel the same way if I were in your shoes. Help me understand though, why do you say that? What goes into your thought process in terms of the challenges we talked about and you not being able to afford it?”
5. I’m too busy right now.
   • This should be addressed early in the conversation, and the value should be demonstrated throughout the consultation. This means “right now, this isn’t important to me”. When this objection arises, dig deeper. Either they’ll want to make it a priority, or they’ll continue to be uninterested for the time being.
     • “I really appreciate you telling me that. What I’m hearing is that this simply isn’t a priority at the current moment – is that correct?”