Doctors at a large hospital have gone on strike. Hospital officials say they will find out what the doctors’ demands are as soon as they can get a pharmacist to go read the picket signs!


Doctors with great bedside manner aren’t supposed to be angry. Unless you are the most relaxed unflinching individual, you will get angry with patients in certain situations. Anger can affect you performance, judgment, reputation, and health. If you find yourself becoming angry too often, it may be a manifestation of burnout, and even if you have infrequent bouts of anger, you should learn to control them.


“I called my allergist on a weekend with an emergency concern. He called me back and didn’t recognize that I was a fellow doctor who he knew rather well. I was shocked at his indignation that I called on the weekend. Once he realized it was me, his demeanor changed to that which it should be for every one of his patients on emergency calls.” Lesson: Don’t act miserable just because you are fed up with taking after hour calls. The person on the other end of the line is probably pretty miserable with their emergency concerns and fears. While these calls are often abusive and could wait until regular office hours, you accomplish very little by being miserable. If you really are that burned out, hire someone to take calls for you on the weekend.


Most often, anger is directed at patients who are belligerent, ignorant, uncooperative, or inconsiderate. You have to identify what gets you upset and find remedies. The habitually late patient readily upsets the time-obsessed doctor. Because the punctuality issue is so common, the remedy is addressed in the chapter on the waiting room.


A Dental Specialist

“With difficult patients, you get mad at them, mad at your staff and 

mad at yourself.”


The Noncompliant Patient

Patients who don’t follow directions that result in failing treatment are another major reason for resentment. You know how difficult your procedures are and how prognosis is dependent on many factors including patient compliance. While some patients are negligent and others are just not capable of following directions, you may tend to take the resultant failure as a personal affront to your ability. You can help alleviate feelings of anger and resentment by documenting each time the patient is noncompliant. Not only will it help to redirect blame when the belligerent patient wants to challenge you, it protects you from a lawsuit, and serves as a reminder that the patient may not be a good candidate for certain procedures in the future.

Fiscal Conflict

It is annoying and anger-provoking to deal with patients who incessantly complain about fees, treatment plans, and the length of therapy. By making sure there are no misunderstandings about the fees and the insurance benefits, the type of treatment and the expected number of visits, you will reduce the resentment and anger associated with this type of patient.

If a patient complains in a frequent or unreasonable way, you must have the fortitude to refuse treatment in a professional non-hostile manner. Offering a less expensive alternative treatment or suggesting that the patient seek treatment at a teaching hospital or clinic may be the best advice.


Because being perfect in an imperfect world is the goal of all health-care providers, there is a particular pressure to perform at a high level of competence. You may experience anger directed at your staff for repeated mistakes. The remedy is to make sure you hire, train well, and fire as needed to develop and maintain the best staff possible. If you pay at the lower end of the pay scale you will not attract or retain the best people. Make sure you devote much energy to training your staff. Many doctors complain about incompetent staff but make no effort towards training.

A common but often unrecognized source of anger occurs when you can’t perform to the level of competence required. Physical and mental decline causes frustration and self-directed anger. It may even result in anger directed unjustifiably towards patients and staff. While physical and mental decline is usually a deficit associated with aging, it can affect practitioners at all ages if they experience any pathology that affects performance.

Something as simple as unrecognized changes in vision can affect performance. Small hand tremors, chronic back pain, stress, diminished memory, and depression are just a few of the maladies that can hurt performance and result in anger and frustration.

You must recognize physical or mental decline when it surfaces and adjust your practice accordingly. One of the best reasons to have disability insurance is to be able to leave practice when necessary rather than continue to place patients and yourself at risk.

Communication Failure

The inability of some patients to understand complex treatment plans and options, fiscal responsibilities, and general directions can be both frustrating and anger provoking for the doctor.

You have a failure to communicate when a patient asks the same question ten times.  You may find yourself becoming angry. Try to smile, take a deep breath and explain again using a diagram for your records and let the patient take home a copy. Because communication is one of the major pillars of bedside manner, remedies are addressed in the chapter devoted to such issues.

Treating foreign patients presents another source of anger and frustration. There is the possible failure to communicate due the language barrier, and unfamiliar customs may be interpreted as being rude, pushy, and belligerent.

Try to be more understanding and recognize that they may have a big disadvantage in communicating. Learn a few phrases in the language of foreigners you may see often in your practice. Not only will it help make them feel more comfortable, it can disarm belligerence they may express as a result of their frustrations in communicating.

Petulance and Diminished Tolerances

Patients who have excessively low tolerance to pain or extremely high levels of anxiety can make you angry. It’s often hard enough to perform technical procedures on the ideal patient, so confronting the anxious patient or the patient who jumps and screams while you are trying to concentrate can affect your performance, your emotional state, and your health. 

As much as you may try to disassociate yourself from the problem patient, you must recognize you are human and entitled to have these feelings of anger and disgust. It is imperative to avoid acting on your emotions.

Because you don’t see these difficult patients everyday, you don’t get much practice in controlling your reaction to them. If you make a concerted effort to recognize that they are not acting difficult on purpose and that they have a true problem, you may be able to have your compassion win out. If you can’t dissociate the behavior from your feelings toward the patient, you must have an escape plan in place.

The escape plan is based on a polite and courteous discussion with the patient explaining that you will not be able to treat them. You must avoid putting blame on the patient (i.e. it’s not their fault that they gag, or jump or scream in the middle of a procedure) and try not to make them feel bad. This can be a touchy conversation, but as long as you know you can have it and dismiss the patient, you feel less pressured to perform under duress.


“Mr. Johnson, I really would like to help you, but I’m unable to work on you when you are so jumpy. I truly understand how difficult this is for you and I want you to get a good result, so I think it would be best to see another practitioner who has more success with anxiety (apprehension, pain control, etc.)”


“Mr. Smith, I know how difficult it is for you to have this procedure done, and I truly wish that I could help you, but I’m sorry that I won’t be able to do my job properly with the way you react to the needles I have to give. I think you will be able to get a much better result if you find a doctor who can either sedate you or give you full anesthesia so that you can be more comfortable.”

After these types of discussions, the patient will either welcome the suggestion, offer to change his behavior, or become belligerent. You have to be ready to deal with each scenario.

If he welcomes the suggestion, you should have the number of a practitioner who performs the procedure under anesthesia. Do some research into this referral since you can be held partially responsible for making a negligent referral if the doctor malpractices.

If the patient promises to try harder, that may be all it takes to modify the behavior to the point of becoming a reasonably decent patient. You still have the out if he can’t manage to perform as required.

If the patient becomes belligerent, be apologetic and again explain in a nice, non-condescending manner that it is for his benefit.


“Mr. Smith, I want you to have the best possible treatment outcome, and I can’t do my job in this manner.  You would have a much better experience if you could be sedated for this and we don’t have that option in our office.”

Preconceived Provocation Toward Anger

Your staff can unintentionally make you dislike your next patient before you even meet them. They do this by telling you the negative experience they just had in their encounter with the patient.

“Dr. Jones, Mrs. Smith refused to let me take an x-ray and she won’t sign the informed consent or the insurance forms.”

We all know how you can’t wait to go in to meet Mrs. Smith. Some of you will enter on the offense, starting off the relationship on the wrong foot. Some practitioners will instruct their assistant to go in there and, “Tell Mrs. Smith, if she doesn’t sign the forms and let you take an x-ray, I won’t see her.”

That’s not the solution used by the doctor with great bedside manner.

Try not to prejudice your feelings with your staff’s disdain for the uncooperative patient. Sometimes the patient’s inappropriate behavior is innocent and your staff may be overreacting. You should always make your own judgments and respond with the wisdom and maturity of a caring professional.


“Hi, Mrs. Smith, I’m Dr. Jones.  I understand you don’t want us to take an x-ray.”

The patient will usually give you their reason based on the fact that they had ten other x-rays at some other office, or they may tell you about their fear of cancer. You explain the importance of why you need another x-ray and assess the degree to which this patient may be unreasonable and need to be dismissed. Once the patient meets the doctor, they usually act like a different person and acquiesce to all of your needs.

The next time your assistant tells you your new patient was rude and threw the clipboard with the patient registration form at the staff, you will know not to be prejudiced. You will confront the patient as if he were a normal human being. If you determine that he is hostile, belligerent, threatening, uncooperative or otherwise repulsive, you should be the one to make the call about dismissing him, not your staff.

Learning that you don’t have to treat everybody should take a lot of the pressure off your psyche and help you to control your feelings. The expression of anger, frustration, resentment, and vengeance has no place in any professional relationship and it will destroy any semblance of bedside manner. It is much better to dismiss the patient who riles you than to punish them by childish, vindictive acts such as making them wait longer to see you or treating them inappropriately.

• Gabriela (2021/10/05 22:06)
I find this really interesting, the fact that we are not foece to treat patients who are disrespectful for sure takes some pressure out but it can be a difficult decision. How to know if at certain point we are just more sensitive and overreacting to one of our \\\"needy patients\\\", whats the real line that we should not allow a patient to cross. During my career I have encountered all type of patients, just today I had a patient who would roll her eyes everytime I tried to do my exam or explain something because \\\"she already knows she needs a RCT\\\". Everything went diffciult with her, from x-rays to just doing an exam. I got that question \\\"are you a student or what?\\\" another day I would have answered yes, I am a resident but I do have some experience in dentistry, i\\\'ve been practicing over xx years but I just said Yes, I am student. After a few more complaints I just offered her to look for a Dr outside of an educational institution. So looking back maybe I was not able to manage my anger at the moment and by having better chairside manners I would have make her feel more comfortable and eventually be able to have the therapy done... On the other hand I also have had the situation were front desk comes in saying a patient is yelling outside and then they come to us an are the nicest so I try to ignore what they tell me and just greet them in as every patient. 99% of the times I have no issues, sometimes is sad to see how pts are with your staff and how they act with you but I guess we are not here to judge their manners just to be the best at ours!
• Craig (2021/10/05 21:56)
I have thought a lot about the last section regarding prejudiced opinions prior to meeting patients. I prefer to go into situations with patients who may give staff a difficult time without knowing details about any recent previous bad interactions with staff or other providers. It allows me to avoid treating patients different from one another based on another person\'s experience, and I often find my interaction with the patient does not match up with the previous interaction.
• Toni (2021/10/05 19:30)
This is a great topic of discussion because we encounter these patient scenarios quite often and will continue to encounter them: language barriers, incompliance, fearful patients (including but not limited to pediatric pts). When we encounter these patient scenarios, we may become frustrated. However, it is important to recognize these difficult situations and not get angry, because anger does not produce better results but in turn could make the situation worse. I also really liked the different quotations/phrasing that we can use and apply in real world situations to improve our patient communication.
• Ben (2021/10/04 20:37)
I agree that we, as the dental professional, must control our anger at all times. Easier said than done, of course. I know that I have let the frustrations of our difficult job come across in my tone, my language and my body language on more than one occasion. Gaining experience in handling challenging clinical situations is certainly helpful in controlling the anger. Being mindful of our frustrations and forcing ourselves to take a few deep breaths will also go a long way towards controlling the anger. I appreciate the advice about not harboring preconceived judgments about patients prior to meeting them for the first time. I\'ve been tricked by this before and have, as you stated, most often found the patient to be reasonable and tolerable. I think it\'s important to remind ourselves that our patients\' actions and words in the dental chair are not personal attacks. Very often their anxiety and apprehension about the experience are what guide these occasionally aggressive, angry or insulting actions and words. Again, easier said than done.
• Toni (2021/10/04 20:35)
This is a great topic of discussion since we have encountered and will continue to encounter many of the patient scenarios described above: language barrier, noncompliance, fearful patients (including but not limited to pediatric patients). This can often result in frustration, but it is important to recognize the scenario and not get angry. Anger does not lead to better results. I also really liked the detailed examples of ways we can phrase certain words/sentences to make the patients feel at ease and improve our patient communication.

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