It's never pleasant to deal with a patient whose demeanour or behaviour is challenging. Leo Briggs offers advice on defusing potential confrontation.

A 'difficult' patient takes many forms. Some people are always challenging, some might be difficult because they are in pain, and some days it might not be them at all, but you, who is causing the difficulty.  

It is not possible to please all of the people all of the time, but there are steps that can be taken to try and minimise the risk of turning a good patient into a challenging one.

Service failures

Appointments are a common cause of frustration for patients. This can range from incorrect appointments, to running late or persistent cancellation by the practice. Make sure your appointment system is fit for purpose and that you have enough time to provide the care you plan to carry out at each visit. If you do start to run late, try and inform as many patients as possible and also let people know roughly how long they are going to have to wait. 

Treatment planning is another area which can lead to difficulties. Many patients do not understand that a treatment plan may need to change due to the evolving clinical situation. It is important to explain carefully to patients any areas where you think things may need to change as the treatment progresses. It is also important to explain the impact this will have on the number of appointments they might need and the length of time the course of treatment might take.

With the best will in the world it is not possible to guarantee a 100% success rate for every patient.

Estimates often need to change due to changes in the treatment plan. Always keep the patient informed of any changes to the costs of treatment and follow up any verbal information in writing. As with treatment planning, try and warn patients before you embark on a course of treatment of any areas where you think the costs might need to change. 

With the best will in the world it is not possible to guarantee a 100% success rate for every patient. Treatment failures and complications can make a patient you have a good working relationship with into a very challenging person to treat. Try your best to manage the expectations of all patients before you start treatment, and during treatment.

Clash of personalities

We don't get on with everyone, but as a professional it is our responsibility to manage our own feelings when treating patients we do not get on well with. It is important to recognise when there is a clash of personalities and to proactively take steps to avoid winding the patient up. 

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A patient in pain can think about very little else, and may become very demanding. A failure to address their pain is likely to make a patient become very difficult. It is very important to make arrangements to see anyone who is in pain as quickly as possible. Try and do the least invasive or least irreversible treatment possible to resolve the pain. Do not expect your patients to make decisions about their long-term care when they are in pain. 


Nobody is at their best when they are fatigued. Many patients may be fatigued when they arrive for their appointment. For example, they may be coming to see you after an exhausting day at work or following a sleepless night due to a raging toothache. Recognise signs of fatigue in your patients and make allowances accordingly. Remember that you might also be fatigued. Try and manage your appointment book as best you can so that you are not doing particularly difficult or taxing treatment at times when you are likely to be tired. This can sometimes be easier said then done, but if you are aware of when you are likely to be tired, you can sometimes take action to avoid it impacting on your patients.


Everyone starts to behave differently when under stress. It is easy to forget that most patients are feeling a certain level of anxiety just because they are having dental treatment. Take into account the levels of stress your patients are under and try your best to minimise their stress levels.

It is also important to recognise that you and/or other members of the dental team might be stressed too. Your stress will be picked up on by others, including your patients. If necessary, learn some stress management techniques which you can employ to try and keep the situation under control. 


Even 'man flu' will impact on your, or your patients' ability to be able to cope with dental treatment. Take into consideration both the short-term problems and any long-term chronic illness that your patients might have when planning how best to care for them. If you are suffering from a condition which might impede your ability to provide care it is vital that you obtain and follow appropriate medical advice. 

Patient expectations

Most patients will be aware of the limitations of the care that can be provided but there are some who will have unrealistic expectations of what can be done. This can range from the length of time it might take to provide treatment, to the end result you are able to deliver. Make sure that you are clear at the outset of treatment about what you aim to achieve and how long it is likely to take. If you have any doubt about your ability to meet a patient's expectations, delay starting the treatment until you are confident that the patient fully understands what you are able to achieve and is happy to proceed. Always consider referring a patient where you have doubts about being able to meet their expectations.  

For advice and guidance on your own individual circumstances, please contact the DDU dento-legal advice team on 0800 374 626.

This page was correct at publication on 07/09/2015. Any guidance is intended as general guidance for members only. If you are a member and need specific advice relating to your own circumstances, please contact one of our advisers.