The hostile patient

July 1, 2018
Kim Miller, RDH, BSDH, reviews a C-shaped instrument for placing sealants, voice-activated perio charting software, a compact water flosser, and a flossing toothbrush.

“There should be a zero tolerance in every workplace for patients who verbally or physically abuse employees. Period.”

Dear Dianne,

The reason I’m writing to you is to get some advice about how to deal with hostile patients. I’m really at a loss as to what to do. I’ve had patients who have threatened to punch me and patients who have yelled at me when I have recommended certain procedures they needed. Most recently, I discovered a draining fistula, an obvious infection at the apex of the root of a tooth. When I mentioned it to the patient, the patient said, “Just shut up and do your job.” I thought that’s what I was doing!

Each time a similar type of incident has happened, I’ve gone directly to my boss, the dentist. Quite frankly, all I get from him is a lot of smoke. He hides out in his office, and I’m left standing there with no direction from him about how to continue dealing with the patient. In every situation, I have remained professional and used common courtesy.

The doctor has spent a lot of money sending our team for verbal skills training, but quite honestly, it hasn’t help me deal with these hostile situations.

What are my rights? How do I keep myself, coworkers, and the office safe? I don’t remember being taught anything about this in school or reading anything about this in our journals. In this competitive market, dental offices have to be concerned about marketing and the reviews they may receive from a patient.

For hygienists or staff members in general, what can or should we do to handle this type of situation? I’m one of the nicest people you will ever meet, but what if a patient actually does hit me, then what?!

Terrified RDH

Dear Terrified,

Verbal skills training usually involves learning how to communicate effectively with reasonable people about dental needs, financing, scheduling, and telephone skills, to name a few customer service scenarios. Rarely would you discuss how to deal with people who threaten you or who verbally abuse you. That’s just not something you expect in a typical workplace. So, I can understand why you feel your formal verbal skills training has not equipped you for dealing with abusive people.

It is disappointing to hear that your boss wimps out when these situations have occurred in the past. It takes courage to stand up to abusive, bullying people. Apparently, courage is not his strong suit, and he lacks the necessary spine to take definitive action. Your boss showed a tremendous lack of courage and support for his team by hiding his head in the sand when dealing with hostile patients. Staff members need to know that the boss has their backs.

I put an inquiry on one of the online forums and asked the dentists what they would do if a patient threatened a staff member or used vulgar or abusive language. Without exception, they replied that immediate dismissal from the practice was first with a warning that should the patient return, 911 could be called. There should be a ZERO tolerance in every workplace for patients who verbally or physically abuse employees. Period. Employers have a legal mandate to provide a workplace that is free from abuse and/or harassment. It’s part of the responsibility of being a business owner and having auxiliary staff members.

The bottom line in this discussion is the employer’s responsibility to maintain a safe workplace, which includes safety from hostile patients. This falls under OSHA guidelines and includes employer obligations to prevent workplace violence. Here is a great link from a legal source on workplace violence:

I urge you to go out and take a look. You will find that there are several court cases where employees were assaulted by patients (not in the dental setting), and there have been some legal decisions and OSHA citations handed down. OSHA is federal, so it encompasses the entire US. Additionally, states can have various rules that are often more encompassing and stringent than federal regulations. If you Google “workplace violence” and your state, you will find numerous resources that address individual state guidelines on the subject.

If a patient threatens you or causes you bodily harm (including striking you), and your boss does nothing, you could sue your boss for neglecting his federally mandated duty to protect you. It is a serious matter. It’s very hard for me to imagine an employer with so little regard for his or her staff members that the employer would not dismiss the threatening or abusive patient from the practice. That’s the least the doctor could do. I also recommend that you or someone else from the practice call 911 and have the abusive or violent patient arrested.

Workplace violence seems to be on the rise. According to OSHA, approximately two million employees are subject to workplace violence each year, including assault or threat of assault. Dental or medical offices are not common venues for workplace violence, but that fact does not relieve the dental employer from his or her obligation to provide a workplace free from threats of violence or abuse. Certainly, it could happen anywhere at any time.

Many years ago, I learned a helpful acronym using the word “DEFUSE” in dealing with angry patients.

Don’t lose your cool. Remember, no matter how angry or irate the patient gets, you must remain calm. If you lose your temper or start arguing with the patient, you can’t concentrate on the true problem.

Encourage the patient to vent emotions. If the patient is allowed to discuss all of his or her problems, that person will be much more likely to help in providing the necessary information. You don’t need to make all of the problems right, but don’t make the patient think everything he or she is feeling is wrong. Use these lines: “I understand your feelings.” “I’m sure if I were in your place I would feel the same way.”

Find out the facts. Get as much information about what happened, what was expected to happen, and what can be done to make it happen. Don’t be afraid to ask the patient anything and everything about the problem. With all the facts in front of you, it is time to begin working toward a solution.

Understand your patient’s feelings. Assume the patient has (in his or her own mind) a legitimate reason for being upset, and then listen for what it is. If you find yourself labeling the patient as a troublemaker or someone who does not know what he or she is talking about, stop and think about the last time you received poor service or felt you had been wronged.

Suggest a way to resolve the problem. After all the facts have been gathered and the patient has expressed his or her feelings about the situation, the problem needs to be solved. You must now inform the patient about what you intend to do. The solution must be conveyed clearly and concisely, using language that the patient understands. When it is not in your power to provide a solution, provide an alternative. Apologize when appropriate.

End on a positive note. Once you have discussed a solution with the patient, make sure his or her problem has been or soon will be resolved in a satisfactory manner. Let the patient know how much you appreciate his or her business, and do everything possible to assure the patient that the situation will be resolved.

All the best, Dianne

DIANNE GLASSCOE WATTERSON, RDH, BS, MBA, is an award-winning author, speaker, and consultant. She has published hundreds of articles, numerous textbook chapters, and three books. Dianne’s new DVD on instrument sharpening is now available on her website at under the “Products” tab. Visit her website for information about upcoming speaking engagements. Dianne may be contacted at (336) 472-3515 or by e-mail at [email protected].