03 June 2024

Dealing with aggressive patients and duty of care to staff

Unfortunately, the CROs get calls asking for advice on how to manage patients who are aggressive or display threatening behaviour to staff and/or the dentist. In some cases a rational discussion with the patient is impossible at the time but it is important to know how to manage it to meet obligations as a safe workplace employer and to meet the AHPRA Code of Conduct professionalism. It is always confronting for members to experience these episodes, and although it seems beneficial to remove the patient from the reception area at the time, this may in fact place staff members at more risk of harm.

A situation may occur without warning, or a patient may be a repeat offender. In both cases it is important that staff have discussed and implemented a management strategy including whose responsibility it is to notify the dentist or practice manager (if they are not present) and method/s of managing the patient. The dentist has a duty of care as an employer to provide a safe workplace for staff and this often conflicts with a concern to appear professional and not be provoked into reactive behaviours as expected from the Code of Conduct.

There are no easy solutions to this problem, but the ADAVB recommends that staff preparation is key to effectively limiting the situation. Have a staff meeting; document the process to be followed and make sure all staff know what to do. There may be key words that can be used to alert other staff members that the patient does not recognize, or a bell to ring which sounds in another part of the practice.

Scheduling difficult patients at the end of a session may help by not having other patients in the waiting room: but there should always be at least 2 staff members present. If staff are fearful and have been subjected to abuse or threats, the dentist should alert the local police station about the threat. Many members who contact the CROs are reluctant to involve police, but it may be the best thing you can do to protect your staff. Members have reported that the local police have been supportive when they have done so. 

The CROs recommend you visit Responding to aggressive customers | Victoria Police and use that as a staff training tool, and you can also ring the CRO team at any time to discuss how to manage these unwanted but unfortunate situations.

Ending a professional relationship

Often after this type of occurrence, a member will want to end the patient treatment. The CROs recommend calling to discuss how this might be done, in particular, what wording to use in communications with the patient. If the patient is in a long course of care such as orthodontics, it may be more difficult to terminate the relationship. The AHPRA shared Code of Conduct states:

 In some circumstances, the relationship between a practitioner and a patient may become ineffective or compromised and may need to end. Good practice involves ensuring that the patient is informed adequately of your decision to end the relationship and facilitating arrangements for the continuing care of the patient, including passing on relevant clinical information.

Seeking advice from the CROs if you are with Guild, or members with other PI providers talking to their advisors, may deflect a potential complaint to AHPRA or demand for compensation so it is an important step. Even if you cannot avoid confrontations with aggressive patients, they can be managed both at the time and subsequently ending the professional relationship.