Many emotions swirl around the dental office. Fear, stress, worry, dread, apprehension, and frustration are all normal and expected. Anger can also be found in the dental office and many dentists have experienced their share of angry patients. But when that anger escalates, practice owners have a responsibility to protect their staff from aggressive, belligerent and threatening behavior.
The Dentists Insurance Company reports several calls to its Risk Management Advice Line from practice owners facing irate patients. Typically, these cases stem from patients who are upset over unplanned expenses, treatment plans they consider unnecessary, failure to achieve expected results from cosmetic procedures or a dentist’s refusal to practice outside the standard of care when a patient attempts to dictate treatment.
It’s one thing for a patient to become angry. But when that anger manifests into threatening behavior such as yelling, cursing, stalking or violence, practice owners must intervene. As employers, they are obligated to provide a safe working environment for their staff, one in which employees are not fearful for their own safety.
In one case reported to the Advice Line, a woman brought her son in for an exam. The dentist recommended placing sealants on a few of his molars. The mother was unsure about the sealants and declined the treatment. The next day, she called the office and said she had changed her mind and wanted to move forward with the treatment after all. She brought her son in the following day and the sealant was applied.
A week later, the mother called the office and stated she wanted the sealants removed, as she had done some research online and was concerned about the risk they posed. The dentist declined, as he was confident in the treatment and it was his professional opinion that removal was unnecessary. The mother called repeatedly and harassed staff members. She showed up to the office with the child, acted belligerently and demanded the dentist remove the sealants. The dentist was out of the office. The patient’s mother screamed and cursed at the office manager and assistant. The dentist ended up offering a refund as a gesture of goodwill.
In another case, a patient demanded a refund for orthodontic treatment that had been performed several years prior. She said she had recently been to a different orthodontist who said he would be able to achieve a better outcome. The original treating orthodontist invited the patient to meet face to face, but did not recommend retreatment. The patient disappeared for some time, then called back and wanted to talk. When the doctor called her back, she again demanded a full refund. The orthodontist refused, as he was confident in his work.
The patient repeatedly called the office demanding her money back. On several occasions, she showed up at the end of the day and either staff or the doctor would tell her they were closed. The patient eventually filed a complaint with the Better Business Bureau and the doctor called the Advice Line. Because the practice wasn’t a member of the BBB, the analyst advised him that he had no obligation to respond to the complaint.
Senior Risk Management analyst Taiba Solaiman said the best course of action to take when faced with angry or irate patients is to remain calm. Respond with a professional demeanor and let them know you are willing to hear them out.
“Sometimes patients just want to be heard,” Solaiman said. “Sit down with them privately and let them know you understand they are upset and that you are willing to listen to their concerns. A compassionate ear can go a long way in diffusing a tense situation.”
Showing compassion does not mean you shouldn’t set boundaries. Be forthright about what is and isn’t achievable or realistic. Let the patient know that you cannot allow them to dictate treatment nor can you practice below the standard of care. Should a discussion become heated, it may be helpful to bring in a third person, such as an office manager or another staff member with whom the patient has a good rapport. Often, a third party can help explain the situation in a way the patient understands.
In instances in which patients demand refunds, it is always within a dentist’s right to do so. Offering patients their money back does not imply an admission of wrongdoing, but rather a desire to bring the matter to a mutually agreed-upon resolution.
“In many cases, offering a refund can be the best way to diffuse a situation and prevent it from escalating,” Solaiman said.
Solaiman cautions that if these efforts fail and the patient continues to harass or threaten you or your staff, it may be a good idea to consider dismissing the patient from care. Ensure that the patient is not midtreatment and follow a formal dismissal procedure.
Unhappy patients are an unfortunate reality of practice ownership. And in many cases, frustration — even anger — is understandable. But when patients cross the line and their anger turns into aggressive or violent behavior, it is your professional responsibility to put a stop to it. Otherwise, you put yourself, your practice and your staff at risk.