“Difficult” dental patients: a grounded theory study of dental staff’s experiences

Abstract

Introduction The “difficult” patient is a well-known and potentially negative character in various care contexts. Objectives This study aimed to generate a conceptual framework explaining the main concerns about “difficult” dental patients, and obtain a deeper understanding of their characteristics, how they affect the dental staff and how the staff think and act in order to manage these patients. Methods Ten interviews were conducted with professional dental caregivers, including dentists, dental hygienists, and dental nurses. The audio-recorded interviews were transcribed and analyzed in accordance with the principles of grounded theory. Results The main concern regarding “difficult” dental patients generated a framework of seven descriptive interrelated lower-level categories grounded in the data, subsumed in the core category “balancing subjective difficulties”. The informants perceived the possession of “showing interaction difficulties” and “having bio-psycho-social complexity”, as characteristic features of “difficult” patients, who could further adversely affect the dental staff by “evoking negative emotions and behaviors”, “hampering self-esteem and job satisfaction”, and “impairing life and health in general”. To manage the dental care of these patients, the staff used strategies aimed at “activating internal and external resources” and “creating adaptive treatment relations” with patients. Conclusions The dental staff’s meaning of the phenomenon of “difficult” dental patients points to specific characteristics, effects, and handling strategies. The core category captures the contradictory dynamics of characteristics and affects as these concepts seem interrelated to the caregivers’ handling capacity. The dental staff’s possibility of handling the main concern through balancing subjective difficulties depends on contextual conditions regarding time, to bring the patient and/or oneself at the center of attention. This indicates a need for further research regarding dental interactions and studies generalizing the outlook on “difficult” dental patients.

What Brings Professional (Dis)satisfaction in Dentistry: A Self-Assessment of Work Environmental Factors Аnd Organizational Communication

“…Even though we considered only the descriptive perspective of the current analysis, it was found that ethical relations with colleagues were a source of a higher level of overall professional satisfaction. In general, excluding interactions with "difficult" dental patients [35,36], multiple lines of evidence have suggested that predictors of satisfaction are greatly connected to factors related to interpersonal relationships (with patients, colleagues, staff) [22,25,26,30,33,34,37,38].…”

Patients’ Satisfaction Regarding Oral Healthcare Services in the North-East Region of Romania: A Preliminary Questionnaire Survey

“…Numerous studies have highlighted the importance of patient satisfaction as a determinant of healthcare utilization, adherence to treatment, and overall health outcomes. Satisfaction levels are influenced by various factors, including the physician’s communication skills, empathy, and competence, as well as the time spent with patients [ 15 , 16 , 17 ]. Additionally, the organizational aspects of healthcare services, such as accessibility, waiting times, and administrative support, also contribute significantly to patient satisfaction [ 18 ].…”

Quality of life, mentalization, and perception of challenging patient encounters in dentistry: A cross-sectional study

“…From a historic perspective it has been common practice within many healthcare professions to refer to such conflicting encounters as encounters with «difficult patients» [ 3 ]. Studies show that the “difficult patient” is also discussed frequently in relation to the dental healthcare setting [ 4 , 5 ], and it appears that certain types of patients, or patient scenarios, are perceived as more stress inducing than others. For instance, when dentists were asked to rank the most intense stressors in their dental practice, anxious patients were ranked fifth among eleven possible, and fear of causing patients pain or unpleasantness was ranked second after time pressure [ 6 ].…”

“…Correspondingly, failure to successfully identify patients’ anxiety could lead to a breakdown of the therapeutic relationship. Indeed, several studies point to stressful and challenging encounters in dental healthcare as the main arena for when mentalization or similar skill sets play a role [ 4 , 21 , 23 ] , and that the outcomes of the challenging encounters could vary based on how the health professionals choose to approach these encounters [ 4 , 23 ].…”

“…In sum, there appears to be good reason to propose a link between mentalization capabilities, perceptions or experiences of challenging patient encounters, and quality of life for the dental health professional. Ultimately, the consequences of challenging patient encounters, and how these are perceived, addressed, and resolved, can have severe impact on both job-related factors, including burnout and job satisfaction, as well as constitute impairments of the life and health of dental practitioners [ 4 , 21 ].…”