Dealing with challenging patients

challenging patientsLeo Briggs, deputy head of the DDU, explains what to do if you encounter a challenging patient.

At the beginning of your career, it is somewhat daunting to deal with patients. The vast majority of patients get on well with their dentists. Unfortunately, in a very small minority of cases, some appointments can escalate. Some patients are aggressive or behave violently towards dentists and other practice staff.

At the DDU, we supported 118 members between 2014-2018.

Cases involved harassment or threatening and aggressive behaviour directed at dental professionals or practice staff.

We also receive advice line calls each year from dental professionals. They worry about how to deal with these challenging situations.

While these figures are low, there were 64 cases in 2017-2018 compared with 54 during 2014-2016. This may demonstrate that the prevalence of such incidents is increasing, it may also show that dental professionals are implementing a zero-tolerance approach. They want advice on how to protect themselves as well as other staff and patients.

There are a number of factors that may lead to a patient becoming aggressive.

Firstly, there may be a disagreement regarding treatment. This was the reason for 39 DDU cases and included patients who were unhappy about the outcome of a procedure as well as patients who believed that the dentist had failed to diagnose their condition and those wishing for a particular treatment against the advice of the dental professional.

Other issues which may result in aggressive or abusive behaviour include the health of the patient, a dispute over fees and being unable to make or failing to attend appointments.

Preventing difficult patients

Undertaking the following may prevent a patient from becoming difficult:

  • Explain all areas of the treatment plan to the patient. This includes any changes to the original plan and the impact this will have on the number of appointments they might need, the length of time the course of treatment might take as well as any changes to the cost of treatment
  • If you start to run late, try and inform as many patients as possible. It is also helpful to let patients know roughly how long they are going to have to wait and consider, if convenient, suggesting alternative arrangements, such as a different appointment slot, to prevent them from experiencing a long wait
  • Try to manage patient expectations before, during and after treatment
  • Keep the patient informed of any changes to the cost of treatment and follow up any verbal information in writing. Before you embark on a course of treatment, highlight any areas where you think the costs might need to change.

How to respond to a challenging patient

It is important that you implement a zero-tolerance policy and that both patients and staff familiarise themselves with it.

The zero tolerance policy should be readily available, for example a notice at reception, in the practice leaflet and/or on the practice website.

The policy should set out how abusive and threatening behaviour from patients will be treated. Ensuring patients and staff are familiar with the policy should mean practice staff are sufficiently empowered to deal with challenging patient behaviour.

Additionally, try to look for clues in the patient’s body language as this can indicate increasing frustration or anger. This also applies to what a patient says and the way they say it.

Try to reduce tension by asking open-ended questions, providing reassurance and not encroaching on their personal space.

This applies to all interactions including those at reception, not just interactions in the treatment room. It is also important to clearly document any abusive or challenging behaviour. 

This may not always be the case, but sometimes the behaviour may be isolated or out of character for the individual involved. It may be appropriate to give the patient the opportunity to explain.

Discuss the situation, look at any difficulties they might be experiencing and follow this conversation up in writing.

Careful decisions

However, if you feel that the professional relationship has broken down between the patient and yourself and you feel you have no choice but to stop treating them, it is important that you are able to justify your decision and that you observe your ethical and contractual obligations.

If it is possible for another dentist in the practice to take over the care of the patient. Offer this in the first instance.

If this is not possible, make sure that you comply with the GDC Standards. Standard 1.7.8 states: ‘In rare circumstances, the trust between you and a patient may break down, and you may find it necessary to end the professional relationship. Before you end a professional relationship with a patient, you must be satisfied that your decision is fair and you must be able to justify your decision.’

Additionally, the GDC explains that you should write to the patient informing them of your decision and the reasons for it. You should also make suitable arrangements for the patient’s ongoing care.

The decision to withdraw care may understandably elicit a negative reaction from a patient.

By carefully managing the situation and communicating effectively with the patient, you can help to avoid the patient making a complaint or contacting the Ombudsman and/or the media. If you have any concerns regarding this, please seek advice from your dental defence organisation.


For more information on the DDU visit www.theddu.com.

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