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“But my tooth didn’t hurt before you touched it!”

Don’t you hate it when a patient says that?

You’ve just worked hard delivering the best treatment you can.  Everything seemed to go well, but later on the patient returned with some discomfort.  And then they utter the classic line, “I don’t understand why it’s hurting now.  It didn’t hurt before you did the work, and now it does.”

Whether the patient is saying this with anger or just casually slipping it into conversation, it is bound to make us frustrated.  So how should we handle this?

In my post, “4 Steps to Persuasive Communication“, I described my framework for effectively expressing your opinion without babbling, rambling, or talking in circles.  Here’s how it applies to our dilemma:

(1)  Thank: We should begin by acknowledging the patient’s grief.  There’s nothing more annoying than feeling like someone isn’t hearing what we’re saying, so let the patient know you understand their concern.

(2) State Objective: In one sentence, clearly state what you want to do to make things better.

(3) Present Argument: This is where you explain your objective in patient-friendly terms.  A well-placed metaphor will help you save words and paint a picture.  The most effective arguments are when you can link your objective to the patient’s concern.

(4) Call to Action: Restate your objective in a positive manner.  Show compassion and confidence.

Here’s an example.  Let’s say you do a Class II composite resin restoration for a patient and they develop some minor cold sensitivity.  They return to your office and you explain that this is not uncommon for resin restorations.  You’re going to start with a bite adjustment and, if the symptoms remain, you’ll replace the filling because there may be an air bubble underneath.  A standard explanation, right? You’re about to adjust the bite and you hear the patient say, “But it didn’t hurt before you touched it!”

Here’s what I would say in response:

It sounds like you’re frustrated that the tooth wasn’t sensitive before the filling and now it is.  I’m going to make it feel better.  Sometimes when we remove disease from the body, we stir up a hornet’s nest.  The hornet’s nest wasn’t bothering anyone, but we know we need to remove it before it becomes a bigger problem.  Well the disease is gone now and I’m going to do whatever it takes to make the healing tooth accept our treatment.”

"Stir up a hornet's nest" is more than just a common expression. It's an appropriate metaphor to help the patient understand their situation.

Other arguments you can present include:

“I’m glad this tooth didn’t hurt you initially, because that would have been a sign that your tooth might need a lot more work to feel better than just a little filling.”  This works well if you suspect the patient is also concerned about money.  You’re introducing the idea that additional expenses would have been needed if the patient had waited.

“I’m glad this tooth didn’t hurt you initially.  There’s no question that it would have hurt you in time.  You made the right decision to remove the disease before it got to that point.”  This works well if the patient is still hung up on the pain issue.

On a related note, if your having difficulty getting a patient to accept treatment because they’re not feeling discomfort, check out this post for tips to help the patient understand their situation.


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