Dealing with an angry patient

Aug. 1, 2009
Recently, my hygienist had a new patient in her chair. She took a full-mouth series of radiographs and performed a full periodontal analysis.

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Dear Dianne
Recently, my hygienist had a new patient in her chair. She took a full-mouth series of radiographs and performed a full periodontal analysis. She discovered several pockets, bleeding, and heavy subgingival calculus. She began to discuss periodontal disease with the patient, and showed him an educational video on the subject. She noticed that he refused to look at the video and seemed to be agitated. When she told the patient that he needed periodontal scaling, he angrily demanded that she “clean” his teeth, stating that all he wanted was a cleaning. She tried to explain that a cleaning was not the appropriate treatment for his condition. All at once, he got up from the chair, ripped his patient napkin off, and declared, “I'm going to sue this office!” as he stormed out the door. Needless to say, we were all shocked at his behavior. My question is: What could we have done differently to avoid this unpleasant scene?
Dr. J

Dear Dr. J,

The first problem I see is that your hygienist was seeing a new adult patient before you. Actually, you should be seeing adult patients to do a comprehensive examination to determine what level of preventive or periodontal care they need. It is doubtful that any patient would behave so rudely with you as this patient did with your hygienist.

I am aware that many dental offices prefer to have new patients seen in hygiene first. After all, hygienists are excellent at gathering data and doing assessments. However, hygienists are not legally allowed to diagnose a patient. When the hygienist sees new adult patients first, she or he is put in the position of talking over findings and needs. While hygienists are capable of performing assessments and chartings, patients with extensive needs are better served by a thorough examination with the doctor first.

Business assistants cannot judge (by an initial telephone call) what level of care the patient will need. That is why many new patients come with the expectation of having their teeth “cleaned,” a term that I wish could be banished from the dental vocabulary. Using the term “cleaning” to describe hygiene services trivializes preventive care in the patient's mind. It is no wonder there are more disappointments in the hygiene schedule than in the restorative schedule. Rather, hygiene care should be called “preventive care,” “continuing care,” or “professional care.”

If you insist on new patients coming through the hygiene department first, you should invoke the “red flag” strategy. Here's how it works. The hygienist would complete the necessary assessments. Let's say she found some level of periodontal disease that will require definitive periodontal treatment. She would then raise the “red flag” by saying, “Mrs. Jones, have you noticed this area bleeding when you brush?” Then at another site, “Have you noticed this area being swollen before?” An intraoral camera works great in these situations.

Then the hygienist would say, “From what I see in your mouth and on the X-rays, there appear to be some problems with the bone and gums. Before I proceed any further, I need to have the doctor look at this.” The hygienist has raised the “red flag.” Then she or he would summon the doctor out of the patient's hearing and inform the doctor of a new patient with periodontal disease.

The doctor would then go to the hygiene operatory and (after introductions) confirm what the hygienist has discovered by saying, “Mrs. Jones, from what I see on the X-rays and in your mouth, you have periodontal disease. It is a chronic infection in your gums that destroys the bone around your teeth over time. We need to treat this infection definitively to get it under control before it does any more damage.” Then the doctor would turn the patient back over to the hygienist.

I urge you to modify your protocol for adult new patients by having them see you for a definitive diagnosis before initiating preventive or periodontal care.

Dianne Glasscoe-Watterson, MBA, assists dental practices in achieving their highest potential through practical, effective, on-site consulting. Call (301) 874-5240 to discuss how your practice management challenges can be solved. Visit Dianne's Web site at or send her an e-mail at [email protected].

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