April 1, 2023
By Lisa Germain, DDS, MScD

I recently read this on an Instagram post:

“Dentist here. Today, a patient walked in and inquired at the front desk about getting a dental cleaning. “Sure” said the receptionist. “We will need to have you register as a patient.” The receptionist handed to the patient a clipboard with the requisite forms on it. “FOR A CLEANING????” shouted the patient in angry disbelief (about having to fill out a health history).  The patient hurled the entire clipboard across the room with such force that it impacted the ceiling at the far end of the reception room. The patient then stormed out and we never saw her again. We always wondered what she did at the next dental office when she was asked to register in the same way.”

Sound familiar?  We have all been there.  It is almost a rite of passage for a dental professional.  While we try to give the best care possible and be professional, maintaining our empathy for someone who is hostile and angry is challenging, unpleasant and often takes an enormous amount of self-control.

Managing conflicts that arise during patient care is not something we learn in school.  Yet it is important to develop healthy techniques to de-escalate these tense encounters and avoid unsafe situations for you and your team.  I have spent many hours with my team discussing useful strategies when dealing with unrelenting, frustrated, unpleasant or uncooperative patients. These now have become an important part of our office culture.

1.     Remain calm and impassive

While your first impulse may be to get defensive when a patient questions your office policies, your expertise, or your judgement, it is imperative to remain calm and not allow them to trigger an angry reaction from you by their behavior.  It is natural to feel like the victim of their misdirected feelings, but if you react with anger back at them, it just puts more fuel on their fire. Even if they are being unreasonable, you will never gain control of the situation and resolution becomes almost impossible.

2.     Listen to their concerns

I like to swing my chair around to face them, lean forward, make eye contact, and let them talk (or scream…whatever). When they are finished, I ask them, “Is there more?”  They may go off again on another tirade but let them get it out of their system.  Once they are done, I repeat their statements back to them in my own words. For example, I might say, “What I hear you saying is that you feel that no one cares that you are in pain, and you have had to wait a long time to be seen.  Is that correct?”  This often completely defuses the situation because they know they have your attention and that someone is listening to them. You are validating their feelings and at the same time you may gain insight as to why they are frustrated and dissatisfied. In the dental office many times patients just feel out of control or just plain scared.

3.     Address their concerns

Ultimately, the patient wants a solution to the problem.  I might ask, “What would make you feel better right now?”  I let them express what they want which gives them a bit of control back.  For example, you can apologize for making them wait but explain that you had fit them in as an emergency between your patients who were on the schedule and that you seized the first opportunity that you could so that you could give them your undivided attention. Then I ask them if I can do an exam. If they are still unreasonable, you can say, “ I want you to know that I hear what you are saying. I cannot fire my entire staff and do this treatment in only 10 minutes so that you can get to the hairdresser.  What I can do for you is take the time to get you out of pain today by doing an emergency procedure and reschedule you to complete the treatment on the first available appointment that is convenient for you.”

4.      Don’t take it personally

People are good at being who they are, not who you want them to be.  If you can objectively say that you are clearly not the cause of the patient’s outburst, you shouldn’t internalize it.  While it is important to take ownership of your reactions, you cannot please everyone. You matter.  Take care of yourself in these situations. Give yourself the grace you would give to others.

5.      Set boundaries

Sometimes patients are verbally abusive to your team, but when you appear they are as nice as they can be.  I will not tolerate abuse of my team members.  On several occasions I have told the patient that there are certain things that we do not allow here, and I need to ask you to be respectful of everyone in the office who in truth are all here to help you. (My office…my rules).

If you still cannot get them to calm down, it may be time to tell them that you feel that the doctor patient relationship has deteriorated to the point where it is in the best interest of both of you for them to seek their care elsewhere. I have only done that once in my entire career.  When the patient was escorted to the reception area, he asked, “Where does she want me to go now?”  My assistant responded, “You really DON’T want me to ask her that question.”