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Dealing with difficult patient interactions

25 February 2019

Interactions between dentists and their patients can sometimes be challenging. Dr Alasdair McKelvie, Head of Dental Services (Africa) at Dental Protection, advises on how best to deal with these situations 

Most of us will have experienced an interaction and outcome with a patient that could have gone better – and which may occasionally end in a formal complaint.

A recent Dental Protection survey of members in South Africa found that 50% of dentists are currently experiencing more demanding patients/higher expectations, with over 80% agreeing or strongly agreeing that patient expectations have increased in the last five years.1

This unsurprisingly correlates with the increasing number of complaints we’ve assisted members with in relation to the Health Professions Council of South Africa (HPCSA) and the South African Dental Association (SADA).

Patient expectations

Could it be that we are inadvertently increasing the expectation gap – which in turn can cause an increase in complaints?

One example of this came when I was approached at the recent SADA congress by a Dental Protection member who was looking for reassurance about a complaint he had recently received.

The complaint was regarding a 16 year old who needed four permanent teeth extracting for orthodontic reasons. There had been no referral letter from the orthodontist, and, in order to save fees, no pre-extraction consultation. When the father returned to collect his son after the appointment he was unhappy that his son had been given three fillings instead of the planned extractions.

By not insisting that an examination and discussion took place before any treatment was provided, the dentist created an impression that this part of the patient’s care was not important. In not explaining why the treatment of caries and the re-evaluation of the treatment plan was needed before the procedure took place, the member had lost the opportunity to manage the father’s expectations.

The member told me he was not overly concerned about the complaint, but he was worried that the consent given by the teenager could be deemed invalid. 


Discussions around risk and potential complications during the consent process make it much easier to manage the potential fall-out if a problem does materialise.

Talking to a patient about a recognised complication after the event can often be uncomfortable, as the patient may say they should have been warned from the outset in the consent process if the complication is recognised. Whilst it may not have influenced the decision to press ahead with the treatment, it still needs to be discussed first.


Our survey also found that over 70% of dentists think that patients would be more likely to complain about unexpected payments – which are often nothing more than a misunderstanding around costs and outstanding co-payments arising from an underpayment made by the medical scheme.1

Expectation created around the obligations of third party funders can, if not properly managed, undermine the consent procedure.

All healthcare practitioners are legally and ethically obliged to give their patients all information about treatment costs. If the treatment includes laboratory items or the services of an anaesthetist, then these costs also need to be discussed.


Many difficult interactions can be avoided through better communication in the consent process. There will still be situations where we have to manage disappointment and unmet expectations in a difficult interaction, and this is where communication can make all the difference.

Here are four steps you can take towards defusing a difficult interaction:

  1. Acknowledge there is a problem and try to summarise and gain agreement about what the key issues are.
  2. Maintain firm boundaries and avoid being drawn into discussions that are not focussed on solutions. Often, finding common ground can stop any further deterioration in the interaction.
  3. Show compassion and demonstrate that you understand why the patient is unhappy.
  4. Keep your focus on securing the best outcome for all involved.

Sometimes managing a patient’s expectations can be a much bigger challenge than the actual treatment itself. Ignoring an unhappy patient may result in you losing control of the situation, and from our experiences, could result in the patient complaining to the HPCSA or even bringing a claim against you.

You can contact Dental Protection for support and advice on how to approach a challenging situation. Get in touch on +27 11 484 5288 or visit us online at

1In June 2018 MPS surveyed 173 dentists in South Africa