Denise Rucci, Managing Director of Communications and Marketing at the Arizona Dental Association was recently contacted by a member requesting advice on how to handle this difficult situation: 

A dentist placed temporary crowns, and when the permanent crowns came in the staff member called the patient to schedule the appointment. During this conversation the staff member mentioned that the patient had a balance due. The patient became verbally abusive at mention of the balance due and refused to schedule the appointment. Several days later, the patient appeared at the office wearing a large knife outside her clothing, verbally abusing the staff and then walked out. Minutes later the door slammed open, and the patient tossed an envelope of money of the floor and left.

 The AZDA member asked:

1. Should I have called the police?

2. The patient was midway through treatment, what are my responsibilities?

3. If this patient appears in our office again, should we attempt to reason with her or simply call the police? 

Should the police have been called after the first altercation? Absolutely. Even without knowing the basics of what the patient actually said to cause the staff to label the vocalization verbally abusive (i.e. was there a verbal threat of injury) the fact that the patient showed up with a large knife exposed constitutes a threat. Just think what would have happened if this patient showed up at a courthouse or airport brandishing a knife. The police should be called so that there is a documented record of the threat. Even if the threatening event took place in weeks past, it still would be wise to contact the police to inform them of the situation.

Jeffrey Tonner, an attorney dealing exclusively with dentists, was consulted regarding what course of action should be taken with this patient in the future, since treatment was not completed. Mr. Tonner said that the dentist and staff do not need to continue treatment on a patient who issued threats. The threat has to be legitimate, and the patient’s actions and comments should be documented within the chart with as much objective detail as possible. In this case, the verbiage that was verbally abusive should be included, as well as the knife placement, description of the knife, any actions such as clenched fists, door slamming etc., that are different from the norm, and that the police were contacted and a report was filed. 

Assuming the money in the envelope satisfies the balance due, the dentist was paid for services. The remaining issue is whether or not to finish treatment not yet completed. Again, Mr. Tonner states that if the threat is legitimate, then a dentist does not have to complete treatment. The money may then be refunded along with a letter of dismissal sent to the patient, but should not mention specifically why the dentist is no longer going to provide treatment, as this could incite the patient even more.  A sample letter of dismissal follows.

Dear Patient:

It has become apparent to me that our professional relationship has deteriorated over the past several {weeks/months}. A healthy dentist-patient association is based upon mutual trust, respect and understanding, which are lacking between us. Without assessing blame to you, my staff, or me it seems now is the appropriate time to terminate our relationship.

If you have an emergency situation within the next thirty (30) days, please contact us and we will do our best to accommodate you. Thereafter, we ask that you seek all dental treatment elsewhere.

You also should select a new dentist soon. Your current condition requires that regular hygiene be performed every {3, 4, 6} months. If you or your new dentist requires copies of your dental records, please send us a written release and we will be happy to forward them to the appropriate person.

My staff and I regret that this situation had to occur. We wish you good luck in the future.

Very truly yours,

{Dentist Name}

If the patient appears at the office again, it would be prudent to call the police immediately. Trying to reason with a patient who has previously exhibited threatening behaviors would only endanger the staff and other patients in the office.

The question has to be asked, “What was the genesis of this event?”  It may be difficult to pinpoint how this situation became so intense. No matter how well or how poorly the person was handled before and during the altercation, no one should be subject to this kind of abusive behavior.

 In order to better manage this situation and plan for the future, meet as a group.  Without being accusatory, ask the following questions:

• Was the patient so frustrated that this was her way of lashing out?

• Were clues left along the way by the patient that were ignored by staff, but if dealt with could have diffused the situation?

•  Does the patient have a medical condition that caused the outburst of behavior?

• Why did she become so verbally abusive on the phone when appointing and following up on financial arrangements?

• Was there a prior inkling that this patient exhibited behavior that was unpredictable and explosive?

• Was every step taken by the staff prior to the abuse to appease this patient as a customer that was appreciated?

This kind of situation could happen in any dental office, and this type of scenario must be discussed with everyone working in the practice. Internal protocols should be instituted and followed for the care of every patient, so that a uniform approach is taken for each patient.

There should be a safety system in place so that staff members will know how to handle this situation should the need ever arise. The procedure on how to handle a disruptive, unruly, disgruntled or volatile patient should be included in your office manual. As frightening as this situation is, it is an obvious reminder of how important it is to be Proactive in managing a business. Prepare your practice so that problems like this are handled correctly and safely.