How to deal with challenging patients in your dental practice

Do you have any patients that, when you see them on the schedule, you get a pit in your stomach and hope they no-show? How often does this happen? For most offices, it thankfully is a rare occurrence, but maybe happens once a month or so. So how do you handle this patient?

I find in many cases, most offices grin and bear it. Often it ruins the day for the doctor and the entire team, as people react poorly to the person and the stress they bring to the office. Sadly, as an outcome of this person in your office, I think that it becomes a lost day, meaning, your performance with the rest of your patients and team becomes so poor that your case acceptance for the day is probably pretty ugly. I have to admit I have never measured this phenomenon, but I would bet money I am pretty close. How would I recommend you handle this in the future? Fire that patient.

I don't intend to sound crass with my previous statement, but if you allow this one person to ruin your entire day and your interactions with the other 10-15 patients, what is this one bad apple costing your practice? The results of this might be staggering. For the sake of arguement, let's assume you do about $10K in dentistry per day (Feel free to adjust to your numbers and work through this process). Let's also assume you typically experience a healthy case acceptance of 80%. So on the average day scheduling $10K in dentistry, you are actually presenting $12,500 and with 80% acceptance, you're scheduling the $10K. While the crabby person is in the office your case acceptance is half of normal. On the cranky day, your case acceptance is 40% and thus results in only $5,000 being scheduled. I assume the crabby person actually shows up for both hygiene appointments per year, sadly. So on those days, you take a $5,000 hit from the normal $10K and a $7,500 hit from what is possible!!! Not too mention what percentage of patients actually schedule for their hygiene appointment. It is reasonable to assume that that success rate drops as well, not to mention the collection rate for the day. I think it is reasonable to assume that the crabby patient costs you between $10K and $15K per year and likely is referring you other crabby patients. This is how some practices end up with a ton of crabby patients.

The million dollar question is: what to do about it? I wouldn't suggest we simply send them a letter saying "good riddance," after all we are in business. That being said, I would sit down with the patient after they do something rude to someone on your team, and let them know their behavior is not acceptable. Very kindly of course, but firmly. Inform them that if they would like to continue this behavior, you would be very happy to send their chart to another office on their behalf (that could better suit their needs if be). My experience when you do this correctly, is that most people will change their behavior. Some, of course, will absolutely freak out on you and this will confirm you made a great decision by dismissing them. It is entirely possible the ones that change will become very enjoyable patients that I find actually appreciate the honesty.

While in an office recently, one of the team members, Renee, was telling me about one of these patients and how rude he was to her. My suggestion to her, since she couldn't make the unilateral decision to fire this patient, was to kill him with kindness. I suggested that she asked him one question, it would have totally changed his attitude, well most likely. "Darren, are you ok today?" How can someone respond negatively to this if asked genuinely? Anyone who would freak out at that, again, is probably not the person you want in the practice.

You can disarm most all situations if handled correctly. For those few of you that can't, I think it is reasonable to let that patient go. You will find the entire team agrees on who these people are. Maybe for Christmas this year, let your team pick a few patients to have this discussion with. It might be the best Christmas present you could give your team.


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Darren Kaberna 

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