How many times have you had a reasonable conversation to find after the event that the other party heard something completely different to what you said? The Irish playwright George Bernard Shaw once said, “The single biggest problem with communication is the illusion that it has taken place”.
Skilled communicator as you may be, many occasions can and will arise whereby the message you believe that you transmitted differs vastly from the message received. Many factors seep into this, some from you, some from your surroundings and some seated in the recipient. Truthfully, are you always giving your undivided attention? Even if you are not sat phone in hand, are you really listening, or is your mind wandering across your perpetual to-do list, your worries, your woes, or places that you would rather be? Loose language and hurried explanations have landed many a practitioner in hot water when they find the patient didn’t actually understand the meaning of a risk that eventuated, and that they therefore had no consent.
Is your recipient actually listening? Are they even able to if your environment is noisy and bustling with incessant distractions? Are you setting either of you up for success if your surroundings are frenetic?
Attention is a finite resource, and you also need to hold firmly in your mind that many patients do not bring the best version of themselves to the practice due to anxiety and fear, and when we are fearful, we are hardwired to shut off higher level thinking to allow our amygdala to drive the bus. The corollary of this is a decrease in our ability to learn new things, as we are primed instead to respond to danger. Add distraction and overly complex or inherently lazy explanations into the mix and we have a recipe for disaster.
Truth, in many ways, could be considered to be a rigid and fixed concept, as surely, there is only one truth? This belief is predicated in the concept that truth is linked to fact. The issue however is that every individual’s perception of facts differs dependent upon many variables; what they have experienced, what they believe they have experienced and critically, what they want to believe they have experienced (sometimes well ‘after the fact’ and through the lens of strong emotions). Is truth then a rigid and immovable object, or elastic like a rubber band? And if it is elastic how far can the band be stretched before it snaps, and do we as clinicians ever get stung by the recoil?
Perception of experience
Perspective is everything when it comes to forming a point of view, and in some instances, a patient can believe they have been harmed by treatment, despite all evidence to the contrary. This is termed a perceived injurious experience (PIE). Perceived injurious experiences can quickly transform into an articulated grievance where the patient not only believes you have harmed them but will move to verbalise this in a ‘name and shame’ manner – this has been aptly termed as ‘naming, blaming and shaming’.
Oftentimes, these beliefs can springboard out of the Karpman Drama Triangle, whereby the patient for whom you have tried your absolute hardest turns on you, and all of your effort, kindness and attempts to go the extra mile count for nought and rebound to hit you squarely in the face. Remember, you will never win an argument with a patient, ever. And, if a patient has formed a strong view that they have been wronged, they are unlikely to take your word for it that they were not, as their truth to them has become absolute. In these situations, the involvement of an independent third party such as the regulator is not to be feared, as these are often the only people who can influence the patients’ point of view.
Belief of experience
Sometimes, it doesn’t serve us to face the truth, either because the truth hurts, or, because it doesn’t get us what we want. On these occasions, individuals may cling to their own version of events, knowing deep down inside the dishonesty of this, because it suits their agenda to do so. More often, people will lie to themselves or convince themselves of the facts, as admitting they are wrong, or bending to reach a compromise is for them, a push too far.
As a clinician, listening to a complaint which is a flagrant lie can be incredibly challenging, but remember it is often far more nuanced than that. So, what can we do to protect ourselves from others who approach the facts with a flexible view of the truth?
1. Records can be everything
As proceduralists, we are highly skilled at documenting the procedures we perform. Equally, we are often more casual than we ought to be at documenting the discussions we have with the patient – if there is a difference in truth, it usually lies within what was said rather than what was done. The unpopular but rigid truth (especially in legal claims) is that the only true way to evidence what was discussed is through your clinical records, so time needs to be taken to consider how these discussions can be captured well. If you are unsure, Dental Protection has resources that can help.
2. Listening isn’t the same as agreeing
There is often a window of opportunity where a patient can be bought back on side, but it does involve actively listening to what they have to say, even if you don’t agree. Never fear that letting someone air their grievance is in some way agreeing with their point of view. We all like our feelings to be validated, particularly when we are emotional, and it is not unreasonable to afford your patients this respect. Utilising active listening skills to help a patient feel that they are understood is the critical factor to successfully navigate through difficult conversations.
3. Don’t take it personally
People are entitled to their opinions, even if they don’t align with ours. While it can feel hurtful and downright offensive when someone doesn’t agree with our perspective, or actively opposes it, getting upset about it only causes you more grief and drama. It resolves nothing. Perhaps seek feedback from a trusted peer so that you can use the disagreement of truth as an opportunity for learning and growth.
Stretching the band
Regretfully, occasions can and do occur where the person stretching the truth is in fact the clinician. This is very, very dangerous.
As professionals, we are held to a higher standard than our patients, with inherent responsibilities such as a duty of candour, the obligation of open disclosure and the requirement to be deemed a ‘fit a proper person’ suitable to hold registration. Stretching the truth, whether that be in the information we give patients, the documentation we keep or the items we claim is not something we can do, as the consequences to our reputation and registration can be severe, even catastrophic in nature.
So, while the truth may indeed be an elastic construct, dependent upon on one’s perspective and beliefs, as professionals, the elasticity of truth is not something we can afford to put to the test.
References available on request.