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Angry Patients and Parents Frequently Lead to Bad Things by Donald E. Machen, DMD, MSD, MD, JD, MBA, CFA and Hollie A. Machen, Esq.

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by Donald E. Machen, DMD, MSD, MD, JD, MBA, CFA and Hollie A. Machen, Esq.

More than 50 percent of professional negligence (malpractice) lawsuits are initiated because of poor interpersonal interactions between the treating health-care provider (or staff ) and the patient or parent. That is a staggering number and completely preventable. It is understandable that people might be dissatisfied with one or more aspects of their interactions with any healthcare provider or their office staff. This is especially true when considered in the context of orthodontic care because of the extended treatment duration when compared with other healthcare services. It is not uncommon for patients and parents to be seen for two to seven or more years depending on what age treatment is initiated and how long retention, etc. is prescribed.

However, it is one thing for a patient to have a complaint about you or your office; it is another thing for that complaint to become negative patient criticism to other potential patients/parents and then quite another for a professional negligence lawsuit to be filed. With this in mind, it is of utmost importance for orthodontists to make every effort to resolve any conflict or complaint before it escalates to this point.

The potential financial loss from both negative patient/parent comments and lawsuits is enormous. It has been estimated in the past, long before social media and the extensive online networks people have developed, that one dissatisfied patient will let 20 other people know of his or her displeasure. Today, you can make your own estimates, however, it is suggested that in our current economic environment, an orthodontic practice would likely not weather a concerted effort by a few unhappy patients or parents.

Here is a simple plan that orthodontists should implement in their practices so as to have the best opportunity to eliminate negative patient comments and prevent any lawsuits.

First, it is essential that each office have a written grievance process that provides an opportunity for a patient or parent to discuss the problem and offer the practice or practitioner an opportunity to remedy the situation. This one protocol will, by itself, all but eliminate the complaint from spiraling out of control and leading to a malpractice claim. Less than one percent of the offices surveyed utilize this process. However, when patient/parent surveys were conducted, it was the most frequently mentioned deficiency. Specifically, patients/parents expressed their frustration with several aspects of the orthodontist/ staff/patient/parent interaction, including two key aspects: a lack of communication and a rigid and inflexible manner of interaction rather than a warm and personal atmosphere when a question arose.

Why do complaints occur? In a perfect orthodontic patient visit, at the appointed time, the patient is greeted warmly by a knowledgeable and friendly orthodontic assistant and escorted into the appropriate treatment area. The orthodontist greets the patient and parent (if a parent is present) and listens quietly to anything that either has to say before examining the patient. The orthodontist asks appropriate questions, if needed, and performs the clinical exam and advises the assistant as to needed treatment for this visit. Also, the orthodontist asks, “is there anything else I have not covered or that you would like to tell me?” Each office is a little different, however, the idea is the same – to convey an empathic and focused attention on providing the highest quality care, in a warm and professional manner.

However, let’s be realistic; things don’t always go as we would like. Although most visits to the orthodontic office are just fine, some aren’t. A perfect example is one that led to the initiation of a lawsuit several years ago. It went like this:

The patient and parent arrive for an after-school visit. The reception area is crowded with other patients and parents. The patient is called back for treatment and the mother accompanies the patient to speak with the assistant and requests to speak with the orthodontist about her concerns, specifically that treatment is not progressing as she thinks it should be. The orthodontist is summoned to the reception desk and before mother has a chance to voice her concerns, the orthodontist states that he doesn’t have time to speak with her about this or any issues because he is too busy during the after-school rush. She will need to make a separate appointment. What the orthodontist did not know was that the mother had taken a half-day off from work and traveled 30 miles just to express her concerns, ask for some explanation and learn what the plan was going forward. A scene ensued with some raised voices and less-than-ideal behavior on the part of both the parent and the orthodontist. The patient and parent left. A few days later, a request for records to be transferred to another orthodontist was received and subsequently, a lawsuit for malpractice was filed. (Note: if the orthodontist didn’t have time for the mini conference with the parent, how will he find the 200-300 hours required for preparation and trial of the lawsuit? In addition, the mental distress to him, the staff and his family is even more devastating.)

While orthodontic staff and practices are generally efficient and compassionate, the process sometimes gets hijacked. A patient walks away with a negative reaction that will either pass with time or lead to repercussions. However, it is important to remember that patient complaints and grievances occur even when you conduct a near-perfect visit.

Here the patient and parent left without their concerns even expressed. Frustration was understandable. Put yourself in this parent’s mindset, especially when it deals with your child and where you took time off of work and traveled a distance for the purposes stated. There was no good ending to the scenario as it occurred. However, it was all avoidable, including all the negative comments made to others about their poor treatment, and what the others in the reception room heard and saw.

The orthodontic practice that adopts a clear policy for permitting people to express their complaints, concerns and frustrations provides an outlet that prevents the escalation of a negative outcome. This process does not have to be elaborate or lengthy.

The key is to let everyone know that you have this complaint resolution mechanism in place; that includes staff, patients, parents, referring dentists, etc. It is useless if no one knows that it exists. Discuss it at the consultation visit and place it in the office policy manual.

Make sure the complaining patient/parent knows that you, the orthodontist, will see the complaint and discuss it with the staff and respond to it promptly. It doesn’t matter what the complaint concerns. Every complaint should be important to you, no matter what the basis.

Our office uses the following process to get started:
  1. We have an office policy.
  2. We educated our staff members on the policy and the process.
  3. We developed a complaint form that we made readily available to patients (Fig. 1).
  4. We include all complaints or dissatisfaction, oral and written.
  5. We review and evaluate each situation.
  6. We identify corrective actions.
  7. We resolve the situation and we always give the patient/ parent or complaining person the opportunity at the time of complaint to express their concerns, even if we were busy. That old saying, “Fast is slow… and slow is fast” seems very appropriate.

Also, remember that even with an effective complaint-resolution protocol, the goal is complaint avoidance. Make sure there is ongoing staff and orthodontist training and review. Carefully analyze any situation that occurs to learn from it and avoid a recurrence of the same or similar conduct.

Among other reasons, the following common reasons for patient dissatisfaction are: 1. lack of communication; 2. excessive wait time; 3. unresolved billing issues; and, 4. rudeness. With the above in mind, we decided that initially calling something a complaint (form) set the wrong tone. So, we call the form: I Need to Speak with You About…

Our office protocol is stated below:

As part of our consultation, orientation and office policy review, patients and parents are conditioned to know that it is very important to Dr. Machen that all of their concerns, questions and complaints related to care or services provided in his office are handled promptly, professionally and consistently. Further, they are told that if our initial informal efforts do not adequately solve your concerns, it is Dr. Machen’s policy to do his best to make reasonable efforts to do so.

Our goals are simple. We want to provide a protocol whereby patients/parents can voice concerns and where all involved can discuss an acceptable resolution. If additional time is needed to review a complaint, a mutually convenient time is set aside for either a follow-up visit or telephone call. However, before any discussion about a future resolution occurs, it is very important at the first encounter that the patient/parent has had the time he or she needed to fully present concerns. It is imperative that the complainant not feel that he or she has been cut-off, shut down or prevented from having the opportunity to completely air the grievance.

At the outside margin, there might be times where the practice has taken what they consider to be reasonable efforts under the circumstances to resolve complaints, but the patient/parent are still dissatisfied. Hopefully, these are not frequent. However, even in these situations, if the patient/parent has been treated courteously, professionally and been given all the time needed to express their concerns, it is far more likely that they will have a different view toward the office than the patient and parent in the previous example. It will be unlikely that either negative comments to the extent mentioned or a lawsuit would be filed.

With the implementation of the protocol, which is part of an overall Encounter-Based Risk Management (EBRM) system, more fully described in our book entitled Risk Management in Orthodontic Practice, this potentially catastrophic initiator for negative patient comments and/or malpractice lawsuits will have been eliminated.
Author Bios
Dr. Donald E. Machen, is the recognized authority on risk management in orthodontic practice, having initiated the discipline in the mid-1980s. He developed, moderated and presented at the AAO’s first national risk management telecast to more than 2,600 orthodontists. He has represented orthodontists, dental specialists, general dentists and physicians in malpractice lawsuits and other legal matters as a trial lawyer and is currently a trial court judge in Pennsylvania, having served for more than 14 years. He is a board certified orthodontist maintaining a part-time practice and is on the orthodontic faculty of Case Western University Dental School and The University of Pittsburgh School of Dental Medicine. He is also an adjunct professor of Law at Duquesne University School of Law where he teaches malpractice litigation. Dr. Machen was the editor of the Legal Aspects of Orthodontic Practice column in the AJO, writing a monthly column, and has authored columns in JCO and Ortho Tribune. He lectures extensively to orthodontic groups, both large and small, focusing on developing highly effective systems for eliminating lawsuits, optimizing patient care and increasing practice referrals. Dr. Machen is the author of Managing Risk in Orthodontic Practice and is managing director of Risk Management Consultants, LLC. He can be contacted at: drmachen@orthormc.com.

Hollie A. Bernstein Machen, Esq. – After graduating from the University of Pittsburgh School of Law, Hollie spent the early part of her legal career as a litigation associate and then partner of the Bernstein Law Firm, a multi-office firm specializing in creditors’ rights. After leaving that firm to raise her three children, Daniel, Lindsey and Roxanne, she began focusing on legal research and writing as a judicial law clerk in Pennsylvania and has remained active in that endeavor for more than 13 years. Additionally, she spent more than five years counseling clients on financial issues as a wealth management advisor at PNC Bank and National City Bank, earning various designations in the financial services profession including that of Certified Retirement Planning Counselor. Presently, in addition to working with clients at Risk Management Consultants, she spends time teaching online legal research skills to attorneys and judges as a research specialist for Westlaw and acts as practice manager for Dr. Machen’s part-time orthodontic practice.
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October 2025
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