Danger at the Front Desk!

What will you do when a violent person confronts your front desk?

(The following is the author’s opinion and not intended to be legal advice.)

On DentalTown.com, there is currently a thread discussing a situation where a patient became belligerent at the front desk.  He was upset over having to update his health questionnaire.  In his rage, he threw the clipboard narrowly missing the front desk personnel.  He then leaned over the counter aggressively yelling at the front desk.

Violence in a dental office seems like a contradiction, doesn’t it?  And fortunately, I think we can continue to consider it a rare occurrence.  But, we are not immune.

There are a number of sources that have documented and studied violent behavior.  And, they all agree there are predictive signs that will alert you to potential danger.  I mentioned situational awareness in a previous blog article.  And good situational awareness will serve you quite well.  I won’t repeat that information here.  Rather I’d like to focus on what you can do to react to situations in your office once they’ve gone sour.

I will preface this discussion with some patient management techniques that are hopefully obvious.  When a patient is becoming irate, ideally you would make every effort to listen and smooth things over with understanding and being helpful.  Offering to help an older patient fill out the health questionnaire, for example, can help the patient save face when he can’t read the small print.  If someone seems to be irrationally irate, you could ask, “Are you feeling OK?”  That may reveal an underlying health or emotional issue.  Empathy can go a long way in keeping difficult patients happy and relaxed.  Just having someone they can talk to can be tremendously valuable to them.

But, that doesn’t always work.  Anyone can have a bad day.  But, there is a line on violent or threatening behavior that has to be drawn.  Some patients may end up crossing that line.  Then what?

Plan for Safety First

First and foremost should be the safety of your entire team.  Once the SHTF (**it hits the fan), it’s no longer time to be nice or “diplomatic.”  Once a patient turns violent or threatens violence, you must act quickly and decisively.  Just like the fire drills in school, you should know exactly what you’re going to do.  The entire office team should know what to do.

Naturally, everyone in the office should know what’s going on.  If the front desk is all alone dealing with a problem while everyone else is in the back working and oblivious, she could be in a lot of trouble.  You need a system or way to alert everyone.  This can be done a variety of ways.  If you have on office communication system, pagers, intercom, and so on, you could set up a “red alert” light, message, or sound.  But, you can be very low-tech and accomplish the same thing.  In my office we have a special word.  If we hear that word shouted out, we know it’s “go time.”  Incidentally, the word or phrase should NOT be “red alert” or “code black” or some such obvious alarm.  Oh… Your front desk probably shouldn’t shout out “It’s GO TIME!” either!  LOL!  😉  The angry person, or bad guy (BG), will know what’s going on, and that may not be a good thing.  The element of surprise can be an advantage.

Instead, the word or phrase should be very “neutral” or even silly that will not convey the same message as “code red!” to the BG.  But, it should be a word that you would not routinely hear in a normal conversation.  So, it could be something like “the envelope please!” Bear in mind I’m making these up as I write.  🙂  Be creative!  It could be “Woof!  It’s SO HOT in here!” Or, “banana split!”  Or even a dental phrase like, “Mrs. Smith’s crown broke!”  Hopefully you get the idea.  No doubt, this will temporarily confound the BG.  But, when any of the office team hears that alert phrase, they’ll know something is not right in the office and can mobilize accordingly.

Now… what you do next can vary widely and is very much dependent on the circumstances at hand.  A call to 911 is probably a good idea.  You could assign a team member to that task.  It’s probably best to go to the doctor’s office in the back or some other phone out of sight of the BG.  Someone should get on the phone right away possibly in a location that is not observable by the BG.  This could also be accomplished with a cell phone.  Another effective approach to consider if possible is for the front desk to dial 911 and leave the receiver off the hook.  Then the 911 operator will be able to hear (and record) everything that is happening.

Naturally, verbal finesse is a good weapon to defuse a situation.  And, most of the time, that’s all it takes.  And, hopefully the BG will just leave the office out of frustration.  But, there is always the possibility that the BG is simply intractable.  He’s not going away and is escalating his threats or actions.  I should emphasize that my advice here is NOT intended as legal advice.  This is just my opinions based on a lot of reading on the subject** and some experience.

Action Plan

In my office, my front desk has non-lethal means by which to defend herself if necessary (pepper spray is strategically located).  Ideally, escape is a good option.  Simply put… movement away from the threat is prudent whenever possible.  But, in many offices, the front desk is really cornered.  But, if I hear my front desk shout the alert phrase, I will personally be on the move immediately.  My other staff will make the call to 911.  And, I will do whatever necessary to prevent any further threat to myself or my team.  Of course, that begins with asking the BG to leave.  Hopefully, it ends there.  If it doesn’t, and it escalates, then you have to decide what you are willing to do.

This is not intended to be an instructive article on self-defense.  You have to decide where you stand on that issue.  You have to determine the totality of the circumstance you are facing.  And, you have your own personal beliefs and moral compass.  Then there is your training and knowledge that come into play.  Of course, you should be familiar with the laws of your state.  That said, I know where I stand.  And, I know my own state laws.  I will not be a victim, and neither will any of my team on my watch.  I will do whatever it takes to stop any threat.  It’s up to you to decide how you will face the unthinkable or violent encounters.

Unfortunately, there are bad people out there.  And, being in a business that serves the public puts us in a position to possibly encounter some of those people.  (See the first comment after this article!) Being prepared, just like those fire drills, is prudent and practical.  When the SHTF, will you be prepared?  Or will you panic?  Again… good people management and communication skills go a long way towards avoiding these situations entirely.  But, sometimes it doesn’t work.  And, the police may not get there in time to prevent a violent person from acting.

After the event is over, everyone in the office should get a piece of paper and immediately write what happened.  Be factual.  Don’t write, “Mr. Smith assaulted Suzy.” Instead write exactly what happened:  “Mr. Smith then threw the clipboard almost hitting Suzy in the face.  Then he leaned over the counter in her direction shouting at her.” The sooner you write down your account of what happened the better.  After the adrenaline dump, you’ll be shaken up, and memory can get fuzzy very quickly.  Filing a report with the police is a good idea.  And, dismissing the patient from your practice would be the next step.

It May Not Be a Patient!

Given the trend of the neighborhood where my office is located, I suspect we have a higher chance of a stranger walking in and causing trouble than an irate patient.  My patients are all very nice people.  But, I have to admit the location of my office has taken a bit of a downturn.  So, all I have discussed here applies equally (and maybe more likely) to such a situation.

If you’ve watched the news, you know about workplace violence.  Oftentimes, it’s an estranged or jealous husband or boyfriend.  It could be a disgruntled ex-employee or even the spouse of a disgruntled ex-employee.  In most dental offices, staff is made up of women.  They range from young and single to “mature” empty-nesters.  Domestic violence is far more common that we’d like to believe.  There is potential for domestic violence brought right to our offices.

That is the reality we either face or ignore.  You likely have a plan in place for medical emergencies such as heart attack and syncope.  You even have a plan if someone gets poked by a sharp and dirty instrument or needle.  Do you have a plan for possible workplace violence? It may be unpalatable to think it can happen in your office.  It’s not something many people even like to talk about.  “That won’t happen here.”  “That only happens to other people or in bad neighborhoods.”

I choose to face this taboo subject and be prepared.  What about you?  I can tell you that your staff will appreciate the concern and effort.  It’s very good for morale when your team knows you will stand up for them and feel strongly about protecting them.

My deepest wish is that none of us ever faces a serious violent threat in our offices (or anywhere else).  It can happen, though.  It HAS happened.  (Check back in to this blog… some dentist friends have promised to post their stories here in the comments.) And, none of us is automatically immune.  Finally, my article is really intended to be thought-provoking.  I’m not suggesting anyone do anything in particular.  This is not legal advice nor a lesson in self-defense.  Read up.  Get training.  There are plenty of resources available to you if you want to explore your options.

**Bibliography (what I’ve read so far).  I’ve highlighted my favorites by bolding them:

Stay safe out there Dental Warriors!

PS:  I’ve written a follow-up to this post:  Danger in the Dental Office – Part 2

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10 Responses to Danger at the Front Desk!

  1. Dawn K, DDS says:

    Hi Mike!! I love your blog, and this one is very relevant. I think there are a lot of troubled people in the world and chances are one of them will, eventually, come wandering into your office. I wanted to share two personal stories with you that are related to this topic, both of which happened to me when I was a little younger and worked as an associate.

    I worked in an office in a small rural community for a time. The senior doctor was a middle aged woman (she’d hate me for saying that!). She was particularly paranoid about locking the door between the lobby and the back office. The coffee pot was in the lobby, and being a coffee addict, I kept locking myself out in the lobby whilst trying to get coffee. I asked her one day, “What’s the deal with the door lock paranoia?” She proceeded to tell me the story of another doctor that used to practice in that town who was now retired. She said that his front desk person was going through a divorce and her soon to be exhusband came into the office and started arguing with her at the desk. During the argument, he pulled out a hammer and began beating her with it, right at his front desk. After that altercation, the dentist closed his office. He no longer wanted to practice. She felt that one of the best ways to prevent this type of thing was to keep that door locked.

    Our staff, and ourselves, really, do have people in life that could be capable of this type of thing. And, the workplace is definitely a place where they know where to find you if they want to seek you out for an argument.

    The other incident I wanted to share happened to me personally. I was an associate at a different office. At this office, I worked the evening shift, and worked alone with one assistant. I had an emergency patient who came in and became EXTREMELY irate when I told him his tooth was too periodontally involved to be repaired. He started yelling and cursing like a mad man. He wanted me to just fix his tooth, which really wasn’t possible. Apparently, his last dentist had told him the same thing, and during his rantings he yelled something like “if my last dentist hadn’t been so old I would have beat him to death.” It was incredibly frightening to see someone go into the red zone so quickly. I told him, “I think its best if you leave.” He jumped out of the chair and leaned over right in my face and said, very angrily, “You don’t know who you’re messing with.” Now, I immediately went into “wolf” mode and said loudly, “LEAVE NOW” and started walking towards him, moving him towards the door. He kept cursing, but I didn’t care, I just wanted him out and we were moving towards the door. I kept saying, “LEAVE NOW.” “LEAVE NOW!!” Somewhere in that mess I instructed the assistant to phone the police. He was gone before the police got there. I started crying as soon as he was out the door, I think just a letdown of all the emotion of the situation, but I was very relieved that he was gone.

    These things can happen, do happen, and its not a bad idea to run through your mind what you would do if it happened in your office.

    • The Dental Warrior says:

      Thanks for sharing those stories, Dawn! I bet there are plenty more out there. It is interesting to note that since I wrote this, I’ve had some dentists dismiss the notion that this happens and that being prepared is overly paranoid. Dental offices are not immune to the same workplace violence we hear about on the news.

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  4. Dr. Adel Zakhary says:

    Hey Mike,

    Very nice article. It happened with my father at our practice. It was a post-treatment cost-benefit issue and the patient relatives started shouting out loud and I wasnt with my father at the same room, but I overheard the conversation. They never crossed the line, but one thing I best remember, is what you said – verbal finesse. My father calmly asked the patient to leave and he informed me to call the security of the building. Before they came up, my father managed to dismiss the patient. I’m very proud of my father, chiefly because he’s a hard-ass, and because if he co-escalated the situation, I’d have had to barge in and start some ass whooping (my father and I can start bitch-slapping as easily as giving an inferior alveolar block) 🙂

    Anyways, plenty of wise points up there. Keep them coming, and by the way, I left a comment at your Picasso Lite laser youtube vid. Please respond to it.

    Kind Regards,


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  6. Jay W says:

    Hey Mike

    Great article. I wish I never had to think about stuff like this, but 6 people were shot about 2 blocks from my office a couple years ago (including our beloved UPS guy) and this topic came up. My staff and I discussed it, and we had a pseudo plan. Now my staff has unfortunately turned over, and we have a new incident! Former patient murdered his ex-lover, also a former patient, and is on the loose. I assumed he was long “gone” but I just read an article that the alleged shooter robbed a bank. Luckily he is 20 miles away from the office, but he could pay us a visit! My staff and I WILL be discussing this topic first thing tomorrow morning.

    Let’s say a guy like this shows up brandishing a gun? What then?

    • The Dental Warrior says:

      Hi Jay,

      Thanks for your comment. I’m betting your former patient is too “busy” to show up for a social visit at your office. I believe the best response to a bad guy showing up is not being there. In other words… Get out. Escape. (Just my opinion… not intended as any sort of official / legal advice)

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