Dentists experienced verbal aggression and reputational aggression most often. More than half of clinicians reported at least one incident of verbal hostility and nearly half experienced a reputational threat within the past year, shining a light on the need to protect dental teams from workplace violence. This is the first study about patient aggression against dentists published in the U.S. and is only the fifth in the world, according to the authors.
U.S. "dentists reported levels of physical, verbal, and reputational aggression at rates comparable with those of other [healthcare] professionals in the United States and abroad," wrote the group, led by Kimberly Rhoades, PhD, a research scientist in the department of cariology and comprehensive care at New York University College of Dentistry (JADA, October 2020, Vol. 151:10, pp. 764-769).
Happens often, not discussed
Workplace violence against healthcare professionals, including dentists, is widespread and often overlooked. In fact, healthcare settings rank second only to law enforcement in the rate of violent incidents.
News sites offer stories of patients threatening or even attacking healthcare professionals over everything from copays to wearing masks. In July, a video of a woman standing inside a dental practice and adamantly refusing to wear a face mask to prevent the spread of COVID-19 went viral. In February, as the pandemic was just warming up, a Florida man was arrested for threatening to shoot up a dental office after staff members wouldn't allow his sister to pick up his dentures. Meanwhile, other patients feed their vendettas by lighting up review sites and social media with scathing comments and allegations of unprofessionalism, misconduct, discrimination, questionable ethics, and mental abuse. These are just a few examples, but the current study aimed to get a better idea of what dentists really experience.
The study included 98 dentists from the New York City metropolitan area who had been in practice for a mean of about 15 years. The dentists answered an online questionnaire about their interactions with patients.
To gauge how often they experienced certain behaviors, the dentists were asked to choose "never," "not this year, but in the past," "once in the past year," "twice in the past year," or "3 or more times in the past year." Some of the questions were inspired by measures of intimate partner violence. Physical aggression was defined by nine actions, including being grabbed, kicked, or pushed. Verbal aggression was defined by seven actions, including insulting, swearing, or threatening someone, and reputational harm was defined by four activities, including threatening to sue, threatening to post bad reviews or comments on social media, and reporting a clinician to a licensing body or government agency, the authors wrote.
Rhoades and colleagues found that 55% of dentists experienced verbal aggression from patients in the past year. Meanwhile, the prevalence of reputational aggression in the past year was approximately 44%, and the rate of physical aggressiveness was approximately 22%.
The numbers were higher when dentists reflected on the abuse they experienced during their careers. Verbal aggression again led, at 74%, followed by reputational aggression at approximately 69% and physical aggression at approximately 46%. Furthermore, aggression prevalence did not differ based on sex, race, ethnicity, specialty, age, years practicing, or average number of patients treated per day, the authors found.
Not without limits
Though the findings highlight issues between dentists and patients that need to be addressed, the study had several limitations. For example, in addition to the data being self-reported by dentists, the sample was small and constrained to a single geographic region of the U.S. Though the study aimed to be an initial step to understanding the extent of patient aggression in dental settings, a large, nationally represented study is needed to determine the true prevalence of aggression at dental practices, the authors wrote.
Research into the causes of and contributors to aggression would aid in the creation of evidence-based prevention and response, according to Rhoades and colleagues.
"Regarding proactive steps dentistry could take, the fact that each year, more than one-half of [U.S.] dentists will likely be the recipient of verbal or reputational aggression and 1 in 4 will be the recipient of physical aggression should serve as a clarion call for the need for training that incorporates both preventative and reactive strategies for addressing patient aggression," they wrote.
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