It's not uncommon for DDU members to phone the advice line when they are concerned that a patient might become angry. Thankfully, it is very rare for patients to become aggressive. But it is important to consider what to do when a patient is starting to become angry, so as to prevent the situation deteriorating to the stage where they then become violent or aggressive.

Workplace considerations

There are a number of actions you can take to make your workplace as safe as possible for everyone who works and visits it.

Engage local police/security in advice about security systems

Ask your local Police Service for advice about the building in which you work. It might be possible for them to come along and carry out a free assessment of the premises. They may then be able to provide you with a report detailing some simple changes you can make to try and improve safety and security on the premises.

Room layout

Think about the layout of the room. Are you able to get out of the room quickly and easily if a patient does become angry, or would the patient find it easy to block your exit? Can you alter the room layout to improve your exit in an emergency? Think about all the rooms which patients have access to, not just the surgeries.

Protocols

Does your workplace have protocols which all staff are aware of and have been trained on? The protocols could cover the roles and responsibilities of all staff members if a patient does become angry.

CCTV - issues of confidentiality

It may be possible to have CCTV in public areas of the practice, but it can be much more problematic to install CCTV in treatment rooms. If you do have CCTV, make sure you have the appropriate permissions to keep copies of the recordings so they can be used if you need to report an incident to the police or other authorities.

Panic buttons/alarms

If these are installed, make sure all staff know what to do if one is deployed. It's sensible to check them at regular intervals to ensure they are in good working order.

Training

Like Basic life Support Training, training on dealing with violent or aggressive patients is something you might want to do regularly so everyone is aware of what to do in an urgent situation.

Patient's history

Some patients may have a history of becoming angry. If you know that a patient can tip over from nervous annoyance to anger, you can take action to prevent this from happening. It is always much better to prevent a situation from deteriorating rather than dealing with it once it has gone wrong.

Domiciliary visits

It is always more difficult to assess the conditions before doing a domiciliary visit. Make sure you have good protocols when you do domiciliary visits and also make sure that someone else is aware of where you are going and your expected time back.

Personal considerations

Dental Register

The Dental Register is published online, and provides access to a full address for each registrant. You must give the GDC an address where they can easily contact you, but you may want to consider using a work address so that patients don't have easy access to your home address.

Ex-directory at home

To avoid unwanted attention at home, some dental professionals make sure that their personal phone number(s) are ex-directory.

Clothing

Some clothing and jewellery can be used by an angry patient to hold onto. Ask the person who carries out an assessment of the premises to provide advice about the best clothing to wear in the workplace.

Body language

Noticing how a patient looks, as well as what they say and the way they say it, can give clues to increasing frustration and anger. Be aware of these and act on them early to prevent the situation deteriorating.

Actions

If you think someone is becoming angry, think about the following list of possible actions you can take to try and reduce the tension:

• employ active listening and open ended questions
• offer reassurance and acknowledgement
• don't encroach on their personal space.

If the situation is deteriorating you may need to consider the following:

• use a panic button or call for help
• leave the room
• call security or the police.

If you are unlucky to be on the receiving end of an angry patient, after the event you should think about any follow up actions that might need to be taken. These could include removal of the patient from the practice list, reporting the incident to the appropriate authorities and even the possibility of pressing charges.

Remember to keep good notes and to take into consideration the emotional effects on both you and others in the practice. It may be appropriate to obtain advice and support for this.