Have you ever been afraid of a patient?

What to do when a patient turns aggressive.

Most of the patients who walk through your practice door each day are friendly, well-mannered people who respect your practice and what you do. They may not listen to every home care suggestion or accept every treatment plan, but they’re willing to work with you and want to improve their oral health.

But there are other patients who are on edge. Maybe there’s extra stress at work, they’re having trouble making ends meet at home, or they’re simply in pain. Whatever the issue, they could snap at any moment and cause a scene in your practice-maybe even scare your team and your other patients.

While it doesn’t happen often, patients can become aggressive when something doesn’t go their way. Here are common situations that could set a patient off, and what you and your staff can do to calm an angry patient down before it goes too far.

The problem
Everybody reacts to different situations in their own way. What might make one patient angry enough to cause a scene at the front desk may just get a “that’s OK, no problem” from another patient. Here’s a rundown of situations that Kathleen O’Donnell, Vice President of Coaching Services for Jameson Management, and Penny Reed Limoli, owner of the Reed Limoli Group, say might cause patients to turn on you:

• The treatment cost more than the patient expected

• Insurance didn’t cover all or any of the treatment

• They didn’t get the cosmetic or functional treatment results they expected

• They spent a long time in the waiting room; time they don’t really have to waste

• The treatment plan or diagnosis you’ve presented doesn’t match what they found online and they think they know better than you

All of these situations can turn a patient against you. While it’s best to avoid some of these situations by never guaranteeing how much insurance will pay, making sure patients know exactly how much they’re responsible for up front, and staying as close to on time as possible, there always will be problems that come up, or a patient who is convinced you’ve done something to wrong him or her.  That’s why you and your team members need to be able to handle it when a patient gets out of hand.

Make the situation private
If a patient starts yelling at your front office staff, someone needs to take the patient out of view of the rest of your patients, O’Donnell said. Move the patient to a consult room or into the doctor’s office. Tell the patient you want to talk this over, but want to go to a more private place so you’re not interrupted by the phone ringing or other distractions. Don’t let the patient stand at the front desk and verbally attack your staff.

Stay calm
These situations can be stressful, so it’s important for you and your staff members to stay calm and find out why the patient is so upset, Reed Limoli said. Calmly let the patient know your practice is committed to taking care of all your patients’ needs, and to do that you must have policies and structure.

“The team must realize this isn’t personal and this patient likely wreaks havoc wherever they go,” Reed Limoli said. “The dentist and team must look at their office policies and how they handle patients to be sure that most reasonable people will be taken care of and pleased.”

Know what to say
Once the patient has been taken out of the public eye, the patient’s negative feelings should be acknowledged, O’Donnell said. Let the patient know you can see he or she is upset that insurance didn’t cover the treatment and can understand how that must feel.

“When they hear you acknowledge how angry they are that helps them move beyond that emotional flooding and get to a more rational way of looking at the situation,” O’Donnell said. “Label the feeling and say it out loud.”

If the practice is in the wrong or has somehow stepped out of line, apologize to the patient, Reed Limoli said. This also will help calm angry patients down and let them see you really do want to work with them to resolve the situation.

If you do apologize, O’Donnell recommends making what you apologize for somewhat vague, particularly when the practice did not do anything wrong.

If a patient gets upset or offended because your office changed a policy and are now collecting fees at time of service, acknowledge how the patient is feeling and let that patient know it was not your intent to upset him or her. Let the patient know you see that he or she is angry, and then explain why the change was made.

“Say I can see you’re angry and I’m so sorry this situation has occurred,” O’Donnell said. “Apologize for the circumstances or for the fact this situation caused the patient to be upset. The patient hears you’re coming half way. You can defuse the situation and have the patient work with you on a reasonable solution on whatever the issue was.”

Prepare your staff
If you don’t prepare them for these types of situations, your team members may not know how to react when an angry patient confronts them at the front desk. Take time during your staff meetings to role play some of these situations, O’Donnell said. Have 7-10 minute training sessions to practice verbal skills, including how to talk to agitated patients.

“The more your team practices in a safe setting the less caught off guard they’ll be by an angry or aggressive patient. They’ll feel ready for it and some of these tools will spring to their mind,” O’Donnell said. “When somebody feels verbally attacked they can get upset or anxious or fearful and that makes it harder to think about these things. Practicing that in regular team meetings will help them feel like they have a tool. We don’t always know when a patient is going to be set off in one of these aggressive or angry ways. “

Know when it’s time to let go
Usually you and your team can resolve these types of situations with the patient who feels wronged. But some times a patient takes it too far, and that’s when it might be time for you and that patient to part ways.

“If the patient continues to be belligerent or violent, it may be best to tell the patient you think their needs would be better served at another office,” Reed Limoli said. “This is a last resort, yet if this patient creates chaos each time they come in or call, it is best for them to either realize they must change their behavior or leave.”

No one wants to cut a patient loose, but you also don’t want that kind of negativity in your practice. Talk to the patient first and give him or her a chance to change the aggressive behavior. If that doesn’t work, it’s time to look at your state’s practice act on dismissing a patient, Reed Limoli said.

Most states require you to give appropriate notice, Reed Limoli said, and she recommends you send it in the form of certified mail. Include how long you are willing to treat the patient on an emergency basis until the patient finds a new dental home. Reed Limoli suggests 30 days.

When you send the letter or talk to the patient on the phone, O’Donnell said it’s best to choose your words carefully. Don’t inflame the situation. You want to minimize any negative reviews or negative word of mouth from that patient, so keep it professional.

You have to be prepared
Most of your patients are pleasant people who aren’t looking to cause trouble. They may not be happy when something doesn’t go exactly how they expected, but they are mature enough to handle it in a calm manner. But there are always those patients who are looking for a reason to get angry, who just want somebody they can yell at or who are just on edge because they’re having a bad day or a bad week.

While these types of patients are rare, you have to be prepared for them. You don’t want a bad situation to get out of hand.

“In many ways, stress and anger in our society is at a peak,” Reed Limoli said. “We must be ready to calmly and gently communicate with people who may be struggling with anger or other emotional issues. While being empathetic, we must also set healthy boundaries of interaction so that we aren’t being bullied or abused by our patients. Do your best to treat others the way you wish to be treated and it will go a long way.”