When being “great with patients” isn’t enough

Dental offices wouldn’t exist without patients, so it makes sense that the patient experience is essential. Because of that, practices work hard to build loyal patient bases, earn five-star reviews, and create welcoming environments.When a dentist is lucky enough to have an employee who is adored by patients, it can seem unthinkable to ever let them go.  

But what happens when that same employee is dismissive to coworkers, resistant to feedback, openly negative, or consistently at the center of team conflict? It’s an unfortunate yet common dilemma. 

Addressing, or even discharging, a “patient favorite” employee may feel risky, but in reality, keeping them can cost far more.  

Hidden costs 

Most dental offices are small, requiring tight-knit teams where collaboration is ongoing. Each role—assistants, hygienists, front desk staff, doctors—necessitates fluid communication and reliance on one another. A team member who is rude, dismissive, or divisive can affect everyone and lead to: 

• Decreased morale 

• Burnout among high performers 

• Communication breakdowns 

• Passive resistance or disengagement 

• A culture of “walking on eggshells” 

Patients may not witness this directly, but they may eventually feel it. It’s like being in a room with a couple when you know they’ve been fighting—they try to act normal and avoid talking about the awkward situation. Likewise, patients may notice tension among employees. For example, they might experience problems with office efficiencies or feel an energy shift toward negativity. 

When employees feel leadership protects a disruptive individual because they are “too valuable,” it sends a powerful message: patient popularity matters more than professionalism, and that perception undermines trust. What about other strong employees? The ones who quietly hold things together? They’ll eventually tire of the toxic environment and look elsewhere. Losing two or three essential employees can impact long-term stability for the practice and set everyone back.  

Patient response 

Many dentists struggle with letting a patient favorite go because they fear backlash. Will patients leave? Will online reviews suffer? Will production drop? 

No doubt, this can happen, but it’s usually less than feared. Patients are often more loyal to the practice and the doctor than to any one specific employee. Transitions that are handled professionally often result in quick adaptations from patients.  

Take corrective action 

Discharge isn’t a requirement. Sometimes these problems can be resolved and allow for long-term employment, but that isn’t a green light to do nothing—issues must be addressed early and clearly. With a toxic employee: 

1. Document specific behaviors, not personalities. Focus on observable actions—interrupting coworkers, slamming cabinet doors—not vague labels like “toxic” or “bad attitude.” 

2. Provide direct feedback. Be specific about what must change. 

4. Tie behavior to team impact. Help the employee understand how their conduct affects workflow, morale, and patient care. 

5. Set measurable expectations and timelines. Improvement should be immediate, observable, and sustained. 

If these steps don’t result in meaningful change, then it’s probably time to move on.  

Time to say goodbye 

If you are spending disproportionate energy managing one employee, that is a leadership red flag. Here are a few others: 

• The team atmosphere improves noticeably when the individual is absent. 

• You feel ongoing anxiety about managing the person. 

• You are consistently making exceptions for them. 

When you remove a toxic presence, problems you had before are gone because communication improves, collaboration strengthens, productivity rises, and everyone feels valued. 

  Letting go of a patient-loved employee can feel risky in the short term, but sometimes that risk is worth it when the hovering black cloud disappears and the sun begins to shine again. The team blossoms and will often work harder to fill the gap.  

Conclusion 

Leadership requires courage. It means protecting not just patient relationships, but the health of the entire team. When leaders avoid addressing behavioral problems for patient popularity, it creates a double standard. Over time, that double standard damages your credibility more than any staffing change ever could. Patient perception is important, but having employees aligned with your practice culture should be nonnegotiable. 

Editor's note: This article appeared in the May 2026 print edition of Dental Economics magazine. Dentists in North America are eligible for a complimentary print subscription. Sign up here.