Handling Patients with Anti-Science Beliefs in Dental Practice
Dentists should use patient-centered communication that validates concerns while providing evidence-based education through shared decision-making, rather than dismissing or confronting anti-science beliefs directly.
Core Communication Strategy
The most effective approach centers on shared decision-making that respects patient autonomy while maintaining evidence-based standards. This framework has been specifically validated in dental contexts where patient expectations significantly influence treatment decisions 1.
Build Trust Through Validation and Active Listening
Listen to and validate patient concerns without attempting to immediately dispel their beliefs 1. Instead of confronting anti-science views directly, ask patients in a nonjudgmental manner about their fears or concerns regarding diagnosis and treatment 1.
Use empathy and relationship-building as foundational tools, as these directly address the perceived risks patients associate with dental care 2. Trust-building through communication and understanding patients' lifestyle and social determinants is essential 3.
Communicate verbally and non-verbally in a respectful and culturally appropriate manner 1. Providers must show empathy, encourage questions and feedback, and give ample time to patients 4.
Implement Structured Patient Education
Use Multimodal Presentation Techniques
Employ visual aids, figures, and plain language to maximize patient understanding 5. Communication should be clear (easy to understand), correct (accurate), concise (to the point), complete (with essential information), and cohesive (well-organized) 4.
Implement an iterative educational process: assess understanding, identify misunderstandings, provide corrective feedback, and summarize information 5.
Frame Discussions Around Morbidity and Mortality
Discuss the morbidity and mortality associated with treatment decisions to frame conversations appropriately 1. For example, when addressing antibiotic prophylaxis concerns, dentists should educate patients about adverse drug reactions including Clostridioides difficile infection, which can require emergency room visits or hospitalization 1.
Provide consistent messaging that decreases defensive medicine practices while empowering patients with knowledge required to make informed decisions 1, 4.
Apply Shared Decision-Making Framework
Structure the Decision Process
Use patient education tools that provide consistent messaging and allow shared decision-making 1. This approach has been specifically recommended to decrease defensive prescribing when patients have misconceptions about treatment necessity.
Ask patients to explain how they weighed risks and benefits to reach their decision, which tests their reasoning ability while engaging them in the process 5.
Document the shared decision-making process thoroughly, including the patient's understanding, concerns addressed, and the final treatment plan agreed upon 5.
Address Specific Anti-Science Scenarios
When Patients Refuse Evidence-Based Treatment
If a patient makes an "informed refusal" of information, respect the request 1. Subsequent information about the patient's condition should be delivered in a culturally relevant and appropriate manner as indicated by the patient 1.
Recognize that patients may trust in prayer, spiritual healers, and advice from family and friends 1. Rather than dismissing these beliefs, acknowledge them while providing medical information 1.
When Beliefs Conflict with Standard Care
Avoid simply asking patients to comply with recommendations, as this approach does not work 1. Instead, address the relational dynamics centered on risks and the desire to reassign risks elsewhere 1.
Use simple, succinct language and proper body language when interacting with patients 4. Show understanding that patients' expectations influence treatment decisions 1.
Common Pitfalls to Avoid
Do Not Adopt a Paternalistic Approach
Global distrust of dominating dentists must give way to person-centered professional strategies 2. Patient-centered care, as opposed to dentist-centered care, empowers patients and practices active listening 2.
Avoid implicit bias that patients will be less compliant with complex treatment regimens, as this stereotype can lead to differential patient recommendations 1.
Do Not Rush the Process
Give ample time to patients for discussion and questions 4. Effective communication not only improves efficiency but also alleviates dental anxiety and fear, addresses needs and preferences, and increases adherence 4.
Recognize that trust development requires time and follows a transformational model from deterrence-based to knowledge-based to identification-based trust 6.
Document and Reassess
Document capacity assessments and decision-making discussions thoroughly, including specific examples of the patient's understanding, clinical reasoning for treatment recommendations, and plans for reassessment 5.
Reassess understanding and capacity when the patient's condition changes or when making different treatment decisions 5. Recognize that understanding can fluctuate, particularly during acute stress or illness 5.