Angela Harkins describes how to handle challenging patients.

Some patients may find attending the dentist stressful, due to dental anxiety, dental pain or because they are embarrassed about the condition of their dentition.

Unfortunately, this can mean that a patient reaction to a treatment plan discussion, delay in being seen, or even a change or cancellation of an appointment can sometimes illicit anger or aggression. However, there are steps that can be taken to reduce the chances of a patient becoming difficult to manage.

Prevention management

It is important that the whole dental team understand the practice policy of zero tolerance to violent or aggressive behaviour. 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.

Early stages of managing a patient who has become challenging

It is better to prevent a situation from deteriorating rather than dealing with it once something has gone wrong. A patient’s body language and what they say, as well as the way they say it, can indicate increasing frustration and anger. Tension can be reduced by asking open-ended questions, providing reassurance and not encroaching on the person’s personal space. This applies to all interactions including those at reception, not just interactions in the surgery.

The NHS GDS regulations in Scotland recognise that in certain situations it may be necessary for the practice to terminate its relationship with a patient and abusive or aggressive behaviour is one such circumstance.

Occasionally, a relationship between a dental professional and patient may fail to become established or deteriorate to the extent that it is in nobody’s interest for the relationship to continue. If you consider that you can no longer treat a patient, it’s important that your decision is communicated sensitively to the patient. In the first instance, give the patient the opportunity to deregister themselves. Not only does this give the patient the chance to find themselves a new dental practice which better meets their needs, but it could also alleviate future disputes. An alternative approach may be a fresh start with another colleague within the practice.

However, if the patient decides not to source alternative dental care you have the ability to remove the patient from the practice in accordance with the GDC’s standard 1.7.8, which states that you must be satisfied that your decision is fair and you are able to justify your decision. The GDC would expect you to write, informing the patient of your decision and the reasons for it and also states that you should make prompt arrangements for the patient’s ongoing care.

Ultimately to remove a patient from a registered list, you will be required to complete a GP200 form, which you can obtain from your local NHS board. This form will require you to state the reasons for your request. However, before completion it is worth contacting the Health Board and your dental defence organisation to explain the circumstances as to why you have taken this decision. 

Ultimate sanction if a patient’s behaviour breaches the practice zero tolerance policy

If a patient does become angry, you need to think of follow-up actions that could be taken. These might include the practice explaining that the patient’s behaviour may lead to them declining to treat them, reporting the incident to the appropriate authorities such as the Health Board and even, in extreme circumstances, the possibility of pressing charges. It is important to clearly document any abusive or challenging behaviour.

To avoid a patient becoming difficult, the DDU recommends undertaking the following steps:

  • Establish workplace training on protocols. Such training might need to include the roles and responsibilities of staff members if a patient’s behaviour deteriorates
  • Having a system in place that allows an individual member of staff to alert the rest of the team if encountering a difficult situation
  • Ensure you have an effective appointment system, which provides enough time to implement the care you plan to carry out at each visit. If you do 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
  • Try to manage patient expectations before, during and after treatment
  • Explain all areas of the treatment plan to the patient.

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