Episode #462: How to Treat the 5 Most Difficult Patients, with Dr. Bill Robbins & Dr. Jim Otten

As a dentist, you want to help everyone. But sometimes, it’s okay to just say no. And to help you handle the impossible-to-satisfy patients, Kirk Behrendt brings back Dr. Bill Robbins and Dr. Jim Otten, instructors for the Global Diagnosis Education study club, to reveal the common types of difficult patients and how they’ve learned to treat them over decades of practice. Even masters make mistakes. And now, you can learn how to avoid them! For more wisdom from the best in dentistry, listen to Episode 462 of The Best Practices Show!

Main Takeaways:

• Understand the types of difficult patients.
• Learn to read red flags for difficult patients.
• Avoid elective aesthetic dentistry on strangers.
• It’s okay to say no. Learn how to do it effectively.

Quotes:

• “The first [type of difficult] patient that I'm going to talk about briefly is the one that I figure out ahead of time is a wack job, or at least that I can't meet their expectations. And the older I get — I'm not great at this — I'm better than I used to be at reading the red flags.” (16:46—17:04)
• “One thing I do not do is refer a wacky patient to one of my friends. It just doesn't make any sense.” (17:21—17:27)
• “One easy fallback as a general dentist is to say, ‘Mrs. Jones, I'm sorry. I just don't believe I've got the skillset to meet your needs.’ And I'm not saying whether it’s emotionally meet them or technically meet them. I'm just saying I don't have the skillset. And they can't really argue with that. I mean, there's not much to say when a dentist says, ‘I'm not the one for you. I don't have the skillset to treat you.’” (17:35—17:58)
• “Being able to say no is not one of my great strengths. But I have gotten better at it.” (18:41—18:45)
• “We’re seekers and we’re healers. And we want to help everyone. We really want to help everyone. And we’ve got to realize that our skillsets are limited. No matter how talented, educated, developed, experienced we are, we all still have limited skillsets.” (18:53—19:11)
• “Whether it’s a behavioral skillset, a psychological skillset, a technical skillset, they're all limited. And we’ve got to know ourselves well enough to say, ‘This isn't something that I could be comfortable doing my best.” (19:18—19:32)
• “The second [type of difficult] patient is the one where I put the veneers in, the value is too low, they call back tomorrow. They go home thinking they're great, but they call back the next day and they tell the front office, ‘I'm not happy with the veneers. I'll need to speak with Dr. Robbins.’” (21:40—21:55)
• “My standard line when I'm seeing a patient that I know is unhappy is, I say to them before we get started, ‘Mrs. Jones, may I say something before we get started?’ And she goes, ‘Sure.’ She’s sitting here like this because she knows I'm going to fight with her about the veneers. And I say, ‘I know you've thought a lot about this over the last 24, 48 hours. And here’s the deal. I promise you that I'm going to listen to what you say because I know you've thought a lot about it. And I'm going to do whatever I need to do to make you happy again.’ And that diffuses all the anxiety in the room.” (22:03—22:37)
• “The second [type of difficult] patient is the one that I see what needs to be done, and I just do it. It’s no fun. But if you do anterior dentistry, you're going to cut some of your own anterior dentistry off. It is part of the deal.” (23:03—23:18)
• “The third patient is the more difficult one, and the one I've probably had to deal with the most. And that is when they call up and say, ‘I'm not happy,’ and I didn't expect it. I thought they looked like a million bucks, and they don't.” (23:35—23:48)
• “The problem is when they are unhappy with the results — sometimes they know why and sometimes they don't — but I can't see it. And that's when I think the difficulty occurs. And that's the patient that's unhappy with something that I can't improve by removing it and doing it over again. So, my classic way of dealing with this is to say, ‘Mrs. Jones, I just don't see what you're saying. And if I don't see it, I can't fix it. So, remember I told you ahead of time that I would do whatever I needed to do to make you happy? So, I'm asking you, what can I do to make you feel good about this appointment?’ So, I'm putting it back in her lap.” (23:56—24:42)
• “What makes the difference is the relationship you have with that individual. Things don't always go the way you want them to. And everyone knows in complex cases, one thing can go sideways and derail the entire experience. Now, hopefully, once it starts going sideways, you catch it so you don't miss it too badly. But if you have a good relationship with someone, they understand. They're willing to work with you.” (28:06—28:35)
• “What I've found through the years is this patient that is not happy with the dentistry commonly gives me a lot of hints along the way that they may be that patient. And the longer I've been at this, the more I'm paying attention. So, one of the pieces of advice I would give to everybody — not just young, but everybody — you've always heard, ‘Don't treat a stranger.’ And we learned in oral medicine, ‘Know about their health history.’ I would propose to you, don't do elective — especially elective aesthetic dentistry — on a patient you don't know really well.” (30:43—31:16)
• “It’s okay to say no. You're not obligated to treat everyone that walks into your office. What you are obligated to do is to take the time to understand their problem and their needs and try to see if there's something you can do to help.” (33:49—34:03)
• “The [fifth type of difficult patient] is the dishonest patient. And that's the one that came in ahead of time with the premise that they were going to walk out with free dentistry.” (34:17—34:27)
• “I don't really know how to figure out who [the dishonest] patient is, because dishonest people are commonly clever, and they have probably done this before, and they’ll probably do it again. So, it’s a small subset, but it’s one that you have to be willing to accept. And then, you have to decide how you're going to deal with it. Are you going to fight with them, or are you going to write the check?” (35:08—35:27)

Snippets:

• 0:00 Introduction.
• 3:12 Dr. Otten and Dr. Robbins’ backgrounds.
• 6:46 How their study club came to be.
• 11:13 Fulfillment in solving complex problems.
• 13:28 Think differently about treating difficult patients.
• 14:04 The first type of difficult patients.
• 18:00 The importance of saying no.
• 19:56 The second type of difficult patients.
• 23:35 The third type of difficult patients.
• 26:21 Learn to master risk assessment.
• 29:41 Your relationship with patients is the key.
• 30:41 The fourth type of difficult patients.
• 34:15 The fifth type of difficult patients.
• 35:36 Set expectations correctly.
• 36:28 More about the Global Diagnosis Education Symposium.
• 42:50 Last thoughts.

Reach Out to Dr. Robbins and Dr. Otten:

Dr. Robbins’s Facebook: https://www.facebook.com/bill.robbins.79656

Dr. Robbins’s social media: @billrobbins91

Dr. Otten’s Facebook: https://www.facebook.com/james.otten.71

Dr. Otten’s social media: @jamesottendds

Resources:

Sign up for The Global Diagnosis Education First Annual Symposium: Why Not You? September 9-10, 2022: https://www.eventbrite.com/e/global-diagnosis-education-first-annual-summit-live-september-9-10-2022-tickets-333598661577

Sign up for the Global Diagnosis Education study club: https://www.actdental.com/gde-home

Best Practices Show Episode 5 - Confessions of a (Former) Single-Tooth Dentist with Dr. Brian Schroder: https://www.youtube.com/watch?v=TIszrmByd_g

Dr. Bill Robbins Bio:

Dr. J. William Robbins, D.D.S., M.A., maintains a full-time private practice and is an Adjunct Clinical Professor in the Department of Comprehensive Dentistry at the University of Texas Health Science Center at San Antonio Dental School. He graduated from the University of Tennessee Dental School in 1973. He completed a rotating internship at the Veterans Administration Hospital in Leavenworth, Kansas, and a two-year General Practice Residency at the V.A. Hospital in San Diego, California.

Dr. Robbins has published over 80 articles, abstracts, and chapters on a wide range of dental subjects and has lectured in the United States, Canada, Mexico, South America, Europe, the Middle East, and Africa. He co-authored a textbook, Fundamentals of Operative Dentistry – A Contemporary Approach, which is published by Quintessence, and is in its 4th edition. He recently co-authored a new textbook, Global Diagnosis – A New Vision of Dental Diagnosis and Treatment Planning, which is also published by Quintessence.

He has won several awards, including the Presidential Teaching Award at the University of Texas Health Science Center, the 2002 Texas Dentist of the Year Award, the 2003 Honorary Thaddeus V. Weclew Fellowship Award from the Academy of General Dentistry, the 2010 Saul Schluger Award given by the Seattle Study Club, the Southwest Academy of Restorative Dentistry 2015 President’s Award, and the 2016 Academy of Operative Dentistry Award of Excellence. He is a diplomat of the American Board of General Dentistry. He is past president of the American Board of General Dentistry, the Academy of Operative Dentistry, the Southwest Academy of Restorative Dentistry, and the American Academy of Restorative Dentistry. 

Dr. Jim Otten Bio:

Dr. James F. Otten is a 1981 graduate of the University of Missouri-Kansas City School of Dentistry. He completed a one-year residency in hospital dentistry with emphasis on advanced restoration of teeth and oral surgery at the Veterans Administration Medical Center in Leavenworth, Kansas. He taught crown and bridge dentistry as an Associate Professor at UMKC before entering private practice in 1982, where he served as Chief of Staff of a large group practice in Fayetteville, Arkansas, before opening his practice in Lawrence in 1984.

Dr. Otten has pursued rigorous post-graduate education since 1986, accumulating thousands of hours in advanced continuing education that he has intentionally applied to his practice in order to develop its personalized care philosophy. He has completed the rigorous curriculum at two prestigious institutions – The Pankey Institute for Advanced Dental Education and the Dawson Center for Advanced Dental Education. Dr. Otten lectures nationally and internationally, and he has recently been asked to join the faculty at the Newport Coast Orofacial Institute in Newport Beach, California.

Dr. Otten has been named a Fellow of The American College of Dentists and an active member of The American Academy of Restorative Dentistry.

In pursuit of excellence, Dr. Otten has gained a considerable reputation, both regionally and nationally, for his expertise in disorders of the jaw joints, as well as crown and bridge dentistry, implant restorations, complex bite problems, removable and partial dentures, and naturally beautiful esthetic dentistry.