As an orthodontist, working with patients with high-conflict personalities can be a challenging experience. Patients who exhibit traits such as aggression, blaming, and manipulation are often unpredictable and may create an uncomfortable work environment. It is best to avoid starting orthodontic treatment on such individuals. However, that is often easier said than done since initial interactions with such patients can be misleading and positive as the doctor-patient relationship begins. Once patients have started orthodontic treatment in our practice, there are ways to manage these patients and minimize risk.
The Warning Signs
The first step in managing high-conflict patients is recognizing the warning signs. Common characteristics of high-conflict personalities include a long history of relationship conflicts, childhood abuse, a view of relationships as adversarial, an inability to accept and heal from loss, and a lack of insight into their behavior. Other signs include:
- Blaming others for their problems.
- Projecting their issues onto others.
- A preoccupation with analyzing and blaming others.
Managing High-conflict Personalities
Once you have identified a patient with a high-conflict personality, it is essential to avoid unrealistic expectations. It is easy to be flattered by a patient referred by someone you respect, but high-conflict patients may idealize and then devalue you. It is also important to avoid apologizing too much, as high-conflict patients often look for someone to blame for their losses. Ideally, you avoid treatment when expectations are beyond what can be delivered, but once we initiate treatment, it is critical to set boundaries and manage potential conflict.
As a helping professional, avoiding bending your rules and becoming emotionally involved with your patients is also essential. It would help if you never worked harder than your patient, as this reinforces their passive position and expectations that you can solve their problems. Finally, avoiding directing anger at your patient is essential, as this can exacerbate their behavior and create a more hostile environment. Other tips for managing high-conflict personalities include:
- Remaining calm and professional.
- Setting boundaries and sticking to them.
- Staying open to all information.
Use Clear and Direct Communication
High-conflict personalities tend to have difficulties with emotional regulation, so clear and direct communication can help avoid misunderstandings and escalated emotions. Use simple language and avoid jargon or technical terms. Repeat key points and ask the patient to summarize what they have heard to ensure they understand. It can also be helpful to set clear boundaries and expectations for the patient’s behavior during appointments.
Avoid Triggering Emotional Responses
High-conflict personalities are often easily triggered emotionally; certain words or phrases can set them off. Avoid using language that could be interpreted as criticism or judgment. Use neutral language and avoid emotionally charged terms. It can also be helpful to validate the patient’s feelings while redirecting their focus to problem-solving.
Practice Active Listening
Active listening is an important skill when working with high-conflict personalities. It involves fully engaging with the patient, listening to their concerns, and reflecting on their words. Active listening can help the patient feel heard and validated, which can help de-escalate their emotional response.
Document Everything
High-conflict personalities are more likely to complain or take legal action against healthcare providers. Documenting everything related to the patient’s care, including phone calls, emails, and appointments, is important to protect yourself and your practice. Be sure to document any incidents of threatening or aggressive behavior.
Seek Support and Consultation
Don’t hesitate to reach out for help when you need it. Working with high-conflict personalities can be challenging, and seeking support and consultation when needed is important. Some support strategies include working with a mental health professional, consulting colleagues or mentors, and seeking legal advice when necessary. There are times when we need to terminate treatment. You and your team must watch for the warning signs and set boundaries. Seek support and intervene with these negative interactions early.
In conclusion, managing high-conflict personalities can be a challenging experience, but it is possible to minimize the risks associated with treating them. By recognizing the warning signs, avoiding unrealistic expectations, and following these tips, you can create a safer and more productive work environment for yourself and your team.
