Personal perspective impacts handling challenging patients

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How dentists view themselves affects how they view challenging patient encounters

Metacognitive skills such as the ability to comprehend the motivations of oneself and others may be helpful to clinicians who struggle to handle challenging encounters with patients. (Image:

TROMSØ, Norway: Interactions with difficult patients and how these situations are perceived, addressed and resolved can affect job satisfaction and cause burn-out, as well as harm the well-being and health of dentists. Researchers at UiT The Arctic University of Norway have investigated the effects of such encounters on the quality of life (QoL) of dental practitioners and whether certain mental strategies could benefit clinicians’ perception of these interactions. They found that dentists’ ability to comprehend their own and others’ motivations affect their perception of challenging encounters and their responses.

The researchers noted that certain patient types, such as anxious patients, pose more stress for dentists. Moreover, patients classified as “difficult” in medical settings have shown higher likelihood of having mental disorders. Hence, patient-centric, empathetic skills are crucial, coupled with introspection and metacognitive activities to understand the patient’s needs and understanding of the situation and the dentist’s needs and interpretation of the patient’s situation.

According to the study, being able to understand and contemplate one’s and others’ mental states is a significant metacognitive ability. This skill of reflective functioning is called mentalisation, and three primary mentalisation modes exist: genuine mentalisation, hyper-mentalisation (overconfidence in understanding mental states) and hypo-mentalisation (lack of confidence). Genuine mentalisation acknowledges the inherent uncertainty of knowing and understanding mental states and not only reduces the chance of stressful encounters but also fosters resilience to stress. Those who tend to hypo-mentalisation report a lower QoL due to constant uncertainty about others’ mental states, leading to stress and social conflict. In contrast, overconfidence, although potentially detrimental in some areas, often leads to increased happiness and positive outcomes in social settings.

In the present study, an anonymous online survey was conducted among approximately 165 dentists and fifth-year dental students from three Norwegian universities to gauge their mentalisation tendencies using the Reflective Functioning Questionnaire, their QoL using the Satisfaction with Life Scale and their perception of challenging patient encounters. Respondents rated how challenging they found six patient types—critical, anxious, aggressive, happy, trustful and indifferent. They reported frequency and extent of exposure to challenging encounters.

Analysis showed no sex difference in QoL or perceived frequency of challenging encounters. Dental students found aggressive patients more challenging than dentists did. Most participants perceived aggressive and critical patients as challenging, followed by anxious and indifferent patients. Participants typically encountered happy and trustful patients and aggressive patients rarely. Mentalisation tendencies influenced perceptions, overconfident practitioners reporting fewer challenges than less confident ones. Overconfidence correlated with higher QoL. A negative association was observed between exposure to challenging encounters and QoL.

The researchers suggested that, when dental professionals believe that they understand patients’ behaviours and mental states, they tend to have fewer uncertainties in interactions. This helps them feel that they can adequately gauge their own and others’ mental states, so they tend to find aggressive, critical and anxious patients less challenging. However, practitioners with a lack of mentalisation skills may feel insecure and uncertain in patient interactions. Neither overconfidence nor lack of confidence in understanding oneself and others ensures optimal patient handling.

Effective mentalisation can aid in identifying and managing patients’ emotional states, impacting stress levels and potential burn-out in dentists. However, there are discrepancies in dentists’ accuracy in detecting certain emotional states. Successful mentalisation can lead to beneficial outcomes for both patients and dentists, while failures could harm the therapeutic relationship.

Emotional competence and mentalisation play crucial roles in stress resilience. This study underscores the importance of considering the psychological and emotional capabilities of dental practitioners, not only for their professional and personal success but also for the enhancement of patient care. The researchers suggested that it is thus necessary to increase awareness of metacognitive skills in dentistry.

The study, titled “Quality of life, mentalization, and perception of challenging patient encounters in dentistry: A cross-sectional study”, was published online on 7 July 2023 in BDJ Open.

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