Zoe Close shares her experience of and thoughts on managing
challenging patients in the practice…
Dealing with a challenging patient is something almost
everyone working in a dental practice will encounter at some point. Having said
that, it can still be a difficult experience and something that some people can
Even if you offer the best service available, there is no
way to stop it from happening – it is part and parcel of running a dental
practice. While sometimes a patient may be agitated because they feel, rightly
or wrongly, that they have received below par treatment, it is important to
remember that there can be a variety of causes for angry or difficult
Understanding the cause
Patients, and sometimes their carers, become challenging,
uncooperative or aggressive for a number of reasons: illness or pain, alcohol
or substance misuse, fear, anxiety, communication or language difficulties,
unrealistic expectations, previous poor experience, or frustration.
It can also manifest itself in different types of
behaviour, all of which you want to avoid for the safety of staff and patients,
and to mitigate the impact on anyone visiting/working in the practice. For
example, a challenging patient can be demanding or controlling, unwilling to
listen, verbally abusive or threatening, physically violent or being bold in
their mannerisms, i.e. pacing the room, throwing their arms in the air.
The first thing to do is to identify the problem. Could it
be caused by a medical condition? If so, treat the patient as far as possible
without putting yourself or others at risk. Or, is it caused by lack of
resources in the practice? Long waiting times, poor communication, and lack of
appointments can all contribute to a deteriorating mood or behaviour.
How to defuse the situation
practice manager I often found that having a good chat over tea and biscuits, with the patient doing most
of the speaking and me listening worked best. Offering solutions or, when
appropriate, actually accepting that we could have done better also helped.
However, when you’re on the reception
desk, patients can be more aggressive as the problem is actually live and
happening. You need to make sure your team are trained and equipped to spot the
signs of challenging behaviour early and understand the practice’s process for dealing
with such behaviour.
Dealing with an aggressive patient takes
care, judgement and self-control in order to defuse and de-escalate the
situation. Below are some steps you can take to effectively manage what is
calm, listen to what they are saying, and ask open-ended questions
them and acknowledge their grievances
them with an opportunity to explain what has angered them. Understanding the
source of their frustration may help you find a solution
eye contact, but not prolonged
- Keep listening
and offering a solution
- If the situation
escalates in a public area, if possible, move the patient to a more
It’s advisable to train staff in conflict resolution and dealing with aggressive behaviour. Most practices are also advised to have a policy for this and make sure your staff are informed and comfortable with what actions they may need to take and behaviours to demonstrate when needed. It can also be worthwhile considering your security requirements.
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