📍   Hey everyone. Welcome back to No Silver Spoons. I'm your host, Sarah Beth Herman, and today I wanna talk about angry patients, and not because I think angry patients are the biggest challenge in a dental practice. Honestly, I think angry patients are usually the result of a challenge that started much earlier.

If you've spent any amount of time in dentistry, you've probably experienced it. A patient calls upset about a balance. Someone leaves a negative review. A patient says they didn't like the dentist. They're frustrated because nobody answered the phone. They're upset about how long they waited, and the conversation inside the office usually sounds something like, "What happened?"

Or maybe even, "That patient was just a difficult patient." Over the years, I've started asking a different question. Not why is the patient angry? Instead, I ask, "What happened before they became angry?" Because most of the time, the complaint isn't where the story starts. It's where the story finally shows up, and that's what I want to talk about today.

I wanna talk about the anatomy of an angry patient. Not how to calm one down, not how to respond to one, not how to win an argument with one. I wanna talk about how they get created in the first place. Because if we're being honest, most angry patients don't wake up on a Tuesday morning and decide they're going to make life difficult for your team.

Something happened. Maybe it was one thing. More often, it's a series of small things, a rushed conversation, a missed expectation, an insurance estimate that wasn't fully understood, a voicemail that wasn't returned, a treatment plan that made perfect sense to the team, but it didn't make sense to the patient.

And here's what I've learned after working with dental practices all over the United States. Most angry patients are not created by bad teams. They are created by good people making assumptions. They are created by offices that are busy, stretched thin, trying to do their best and unintentionally leaving gaps in communication.

Because when patients don't know what's happening, they create their own story. I've done that before.  And usually, the story they're creating isn't helping you. That's why I've said for years, " When we create clarity on the front end, we remove ambiguity on the back end." And nowhere is that more true than inside of a dental practice.

The reality is that patient communication impacts everything from treatment acceptance, patient retention, online reviews, dental practice growth, case acceptance, team morale, the overall patient experience, all of it Now, before we jump in, I want to thank today's sponsor, Dentistry Support Academy. At Dentistry Support Academy, we help dental teams strengthen communication, improve patient experience, increase treatment acceptance, and create systems that support long-term practice growth.

Whether it's through our on-site training, virtual coaching, or twelve-week team development programs, our mission is simple: help dental teams become more confident, more consistent, and more effective. Because great practices aren't built by accident, they're built intentionally. Now, let's get into today's episode.

One of the biggest mistakes I see in dentistry is that we spend a lot of time talking about what happened and very little time talking about why it happened. Think about the last upset patient that your office dealt with. Maybe they called about a bill. Maybe they were frustrated because insurance didn't pay what they expected.

Maybe they're upset because they feel like they had to wait way too long. Maybe they left the office without scheduling treatment. Maybe they wrote a negative review. Whatever the situation was, I want you to think about something. What if the thing they're complaining about isn't actually the problem?

What if it's just the place where the problem finally became visible? I see this all the time with billing. A patient gets a statement, and they call upset. Now, everyone is talking about the statement, but I wanna rewind. Let's go backward for a minute. What happened when the treatment was presented?

What happened when the financial arrangements were discussed? What happened when insurance was explained? What happened when the patient checked out? Did someone verify understanding? Did anyone ask, "Before we move forward, what questions do you have?" Or did everyone assume everything made sense because the patient said yes?

Because there is a huge difference between explaining something and making sure it was understood.

And I think that's one of the biggest communication challenges inside of dentistry. Many dental teams believe communication happened because information was delivered, because a signature happened or an initial was obtained. But communication isn't measured by what we say or what kind of signature we have, or how many times we gave an initial on something.

It's measured by what the other person understands. That's a completely different standard. The patient may have nodded, they may have smiled, they may have said OKAY, they may have signed on the dotted line You may have made sure they dated it correctly, and everyone in the office assumed that they understood.

But understanding and agreement are not the same thing and understanding and silence are definitely not the same thing. I've seen patients leave a treatment consultation completely overwhelmed, and nobody even realized it. And not because the team wasn't good, and not because the doctor wasn't good, but it was instead because everyone was operating from a different level of knowledge.

The doctor talks about dentistry all day. The treatment coordinator talks about dentistry all day. The office manager talks about dentistry all day. The patient does not, and that knowledge gap, it really does matter. One healthcare study found that communication issues remain one of the leading drivers of patient dissatisfaction across healthcare.

Not treatment outcomes, not clinical quality, communication. And think about that. Patients often leave frustrated, not because they didn't receive information, but because they didn't understand what they received. That is a very important distinction, and it's one that we don't talk about enough. now let's take this a step further because I don't think frustrated patients are only created through communication breakdowns.

I, I think they're also influenced by the personalities inside the practice. Every office has personalities, every office. And before I go any further, I wanna make something very clear. I am not talking about good personalities or bad personalities. I'm not talking about right or wrong. I'm talking about different ways people naturally communicate, because those differences also matter.

So, let's start with your rockstar. You know exactly who I'm talking about. Every office has one or has had one. They're fast, they're capable. They know the software, they know insurance, they know scheduling. They know where every form is. They know how to solve every problem. They're the person that everyone depends on.

Honestly, they're incredible but there's something I have noticed about them. Sometimes the rock star accidentally creates confusion, and not because they're careless, not because they don't care, but because they're moving at a speed that patients can't keep up with. They know the process so well that they forget what it's like to be hearing it for the very first time.

Have you ever watched someone explain something they know extremely well? They skip steps without even realizing it. They fill in blanks automatically. They assume understanding because they understand it. And that's exactly what can happen in a dental office. The rock star isn't creating frustration intentionally.

They're creating it because they're efficient, and efficiency without clarity, it creates confusion, or at least it can. That's the important lesson for every office. Sometimes your strongest employee is also creating opportunities for the very misunderstandings that you're combating, and not because they're doing a bad job, because they're doing a great job at a speed that the patient can't follow.

Now let's talk about another personality type that I see all the time in dental offices: the approval seeker. This is the person who genuinely wants everyone to be happy. Patients love them. They're kind. They're caring. They're warm. They're usually the first person to volunteer to help. They're often the person who takes the patient complaints personally because they truly want people to have a great experience, and there's so much value in having someone like this on your team.

But every strength has a blind spot. The approval seeker doesn't like disappointing people. They don't like uncomfortable conversations. They don't like conflict, and because of that, they sometimes soften information that needs to be delivered clearly. Maybe they know a patient has a balance. Maybe they know insurance may not cover everything.

Maybe they know a treatment estimate could change. But because they don't want the patient upset, they unintentionally make the conversation less direct, and here's the problem with that. When we avoid discomfort today, we often create bigger discomfort tomorrow. The patient leaves feeling good. Then two weeks later, they receive a statement.

Now they're confused. Now they're frustrated, and now they feel blindsided, and not because anyone lied, but because the conversation wasn't clear enough. One of the best lessons I've learned in leadership is this: clear is kind. A lot of people think kindness means avoiding hard conversations, but I don't believe that.

I think kindness means helping people understand exactly what's happening, especially when the conversation is uncomfortable Let's move to another personality, the controller, the person that loves systems. They love organization. They love consistency. They know policies.

They know procedures. They know exactly how things should be done. And every great practice needs people like this, because without structure, everything falls apart. You know that. But when frustration enters the conversation, controllers, they sometimes struggle, and not because they don't care, because they immediately move into problem-solving mode.

The patient says, "I'm upset." The controller starts explaining policy. The patient says, "I don't understand why this happened." The controller starts explaining process.  The patient says, this doesn't feel fair." The controller starts explaining rules. Now, if you listen to this podcast every week, you know that a few weeks ago, I shared a very personal story that happened to my family in a dental And if you go back and listen to that you will absolutely hear that the front office team member that I spoke with was definitely a controller. Go back and listen to that episode. Hear what happened. Hear how it went down

Here's what I've learned about controllers, and here's what I've learned about people in general. People usually don't want an explanation first. They want acknowledgement first. That doesn't mean agreement, it means recognition. Sometimes a patient simply needs to hear, " I can understand why that caught you off guard."

That's it. Not because you're admitting fault, not because you're taking blame, because you're acknowledging their experience. The strongest communicators I've worked with, they know how to separate those two things. They can acknowledge emotion without accepting responsibility for something that isn't their fault.

That's a skill, and like any skill, it can be learned Let's talk about another personality that exists in almost every dental office, and if it isn't in yours, I would encourage you to look for this one. This is the relationship builder. This person is magnetic. People love them. People remember them. They can walk into a room and immediately make someone feel comfortable.

They remember names. They remember family members. They remember details. They are fantastic at creating connections, and that matters because dentistry is still a relationship business. People don't just choose a dentist, they choose an experience, they choose a team, they choose people they trust. But relationship builders, sometimes they make assumptions.

They assume relationships will compensate for weak systems, and unfortunately, they don't. A patient can absolutely love your team and still become frustrated. A patient can absolutely trust your office and still feel confused. A patient can absolutely enjoy every interaction they have with you and still leave upset about a financial misunderstanding.

Relationships help. They are important, but relationships do not replace clarity. They do not replace communication or expectations. They support those things. They don't replace them. Now, let's talk about one more personality, the quiet observer. This is one of my favorite personalities in an office because they notice things that other people miss.

They see patterns. They pay attention. They pick up on tension. They often know something is wrong long before everyone else does. But here's the challenge: sometimes they don't say anything. They see a potential issue. They notice a patient looks confused. They recognize a communication breakdown. They sense a problem coming, but they assume someone else sees it too, or they don't want to interrupt, or they don't feel comfortable speaking up, and then the problem grows.

Something I wanna encourage leaders to do is to create an environment where observations are welcomed. Some of the best solutions I've seen come from team members who weren't the loudest person in the room. They were simply paying attention.

N-now let's bring all this back to the patient because I want you to think about something. Every patient who walks through your door is carrying something that you know nothing about. Maybe they're worried about money. Maybe they're embarrassed about their teeth. Maybe they had a terrible experience at another dental office.

Maybe they're terrified of dentistry. Maybe they're dealing with something happening at home. Maybe they're overwhelmed. Maybe they're exhausted. And the reality is, is that people don't always communicate those things. They show them. They show them through frustration. They show them through impatience.

They show them through defensiveness. They show them through skepticism. And if we only pay attention to the behavior, we miss the opportunity to understand what's underneath it. And one of the most powerful shifts a team can make is moving from what's wrong with this patient I wonder what's driving this reaction.

That question changes everything because it creates curiosity instead of judgment, and curiosity is where great communication begins. I remember working with a practice years ago that had a patient who was constantly irritable and frustrated. Every appointment seemed to create another issue.

The team was exhausted. They felt like no matter what they did, this patient found something to complain about. Eventually, someone sat down, and they actually listened to this patient. Not the complaint, but the person. And what they discovered was that the patient had spent years avoiding dental care because of a traumatic experience.

You see, the patient wasn't angry. They were scared. Now, does that excuse behavior? No, it never does. But it completely changed how the team approached the situation. And that's what's so important because understanding isn't the same thing as excusing. You can understand someone without agreeing with them.

You can have empathy without allowing inappropriate behavior. You can remain compassionate while still maintaining boundaries. Great teams, they know how to do both Now let's talk what I believe is one of the biggest contributors to patient frustration in dentistry: assumptions.

Assumptions, they show up everywhere. We assume patients understand insurance, treatment, timelines, fees, next steps. We assume patients understand what's expected of them, and assumptions are expensive because every assumption creates the possibility of misunderstanding. And one of my favorite questions to teach my teams is this: " What questions do you have?"

Not, "Do you have any questions?" Those sound similar, but they are very different. When you ask, "Do you have any questions?" Most patients, they say no. When you ask, "What questions do you have?" You are assuming questions exist, and that small shift creates a completely different conversation.

It's one of the simplest communication tools I've ever taught, but it's one of the most effective because patients often need permission to ask. They need permission to admit confusion. They need permission to say, " I don't understand." And if we don't create that space, they often leave with uncertainty.

Then uncertainty turns into assumptions, and assumptions often turn into frustration, which brings us right back to where we started, the angry patient. Or maybe I should say the frustrated patient, because most of the time, frustration isn't showing up because one thing went wrong. It's showing up because several small things went unnoticed and the offices that consistently create exceptional patient experiences, they understand that.

They're not waiting for patients to become upset. They're paying attention to the moments before frustration has had a chance to grow. Now let's get practical, because at this point, you might be thinking, "okay, Sarah Beth, I understand where frustration comes from.

I understand the role communication plays. I get it. The role that personalities play. Sure, whatever." But where do most offices actually get themselves into trouble? And if I had to narrow it down, after twenty-plus years of working with dental practices, I'd say there are five places where frustration gets created more often than anywhere the first one is the phone. The second is scheduling. The third is treatment presentation. The fourth is insurance, and the fifth is billing. And what's interesting is that none of those things are clinical. Think about that. Most patient frustration doesn't start because of the dentistry. It starts because of the experience surrounding the dentistry.

So let's start with the I always tell teams this: The phone is your first opportunity to create confidence or to create doubt. And unfortunately, patients make decisions faster than we think. If someone calls your office and they can't get through, if they leave a voicemail and they don't hear back, if they get transferred multiple times, if they feel rushed, if they feel like they're interrupting someone's day, they're already creating a story about your practice.

And the challenge is that once someone starts telling themselves a story, everything else gets filtered through Now, every interaction that follows is viewed through that lens, and that's why front office training matters so much. Not because we're teaching people how to answer phones. We're teaching people how to create The second place frustration gets created is in scheduling, and I know some of you are already laughing because scheduling is one of the hardest parts of dentistry. Patients want early mornings, evenings, Fridays, next week. Everybody wants the same appointments. Everybody wants the same date. I get but scheduling frustration isn't usually about availability.

It's about expectations. A patient can handle not getting the exact appointment they wanted. What they struggle with is feeling like nobody cared about helping them find a solution. There's a difference. People are often more understanding than we give them credit for when they feel heard the third place is treatment presentation.

And honestly, this may be one of the most important conversations in the entire practice because this is where treatment acceptance is won or lost. And I think one of the biggest mistakes dental teams make is believing that treatment acceptance is about persuasion. I don't. I think treatment acceptance is about understanding.

If a patient understands the problem, understands the solution, understands the timeline, and understands the financial commitment, they're in a much better position to make a decision. But when any one of those pieces is missing, uncertainty enters the conversation, and uncertainty is expensive. It delays treatment, creates hesitation, creates objections.

It creates confusion, and not because the patient doesn't care, but because they don't have enough confidence to move forward. And confidence comes from clarity, not from pressure. The fourth area is insurance. Now, let's be honest. Insurance creates frustration for everyone. Patients get frustrated. Teams get frustrated.

Doctors get frustrated. Insurance companies create enough confusion for all of us. But here's where offices sometimes contribute to the problem. We talk about insurance as if patients understand how insurance works. Most don't. They don't understand annual maximums or frequency limitations or downgrades or why something was covered last year but it isn't covered this They don't understand why the estimate changed. And if we're not careful, we accidentally create expectations that insurance was never going to meet. And a really important phrase that your team can learn is this: " Based on the information we have today, this is our best estimate." Simple, clear, honest, no guarantees, no surprises, no assumptions.

It's just it. Based on the information we have today, this is our best estimate. And finally, billing, the place where frustration often becomes the most visible. Notice I didn't say billing is where the frustration starts. I said it's where it becomes visible. Because by the time a patient is upset about a statement, the opportunity to prevent that frustration probably happened weeks earlier.

That's why I always encourage teams to stop looking at the bill and start looking at the journey. What happened before the statement arrived? What conversation could have been stronger? What expectation could have been clearer? What opportunity was missed? Because that's where the learning happens. Now, I wanna talk about something that I think is incredibly important, and honestly, one of the biggest lessons I've learned as a consultant, as a trainer, as a leader, as a CEO.

I have hired over seven hundred employees. Most angry patients are created by good people. I know I've said it already in this episode, but I really want you to hear it. Most angry patients are created by good people.  Good people trying to move quickly, good people trying to help, good people juggling ten things at once, good people doing the best they can with the training they've received.

And that is why blame is rarely productive. Because when we blame people, we stop learning. Instead of asking, "Who caused this?" I want teams asking, " What can we learn from this?" That's where growth actually happens. That's where better systems happen. That's where stronger communication happens.

That's where better patient experiences happen. And ultimately, that's where better dental practices are built. Now before we wrap up this episode, I wanna leave you with the framework that I think every dental office can use immediately. When a patient becomes frustrated, we don't rush to defend, we don't rush to explain, we don't rush to prove that they're wrong.

We slow down, we listen, we understand, we clarify, we solve. We listen first. We understand what's actually being said, and we clarify what's creating confusion, then we work together toward a solution. You see that process, it sounds simple, but you'd be amazed at how many situations improve when people simply feel heard.

 Now, one of the reasons Dentistry Support Academy exists is because most team members have never been formally trained on any of this. They're trained on software, scheduling, insurance verification, check-in procedures. But communication, conflict resolution, patient psychology, expectation management, leadership, most people are expected to figure out those things as they go.

And that's exactly why we built Dentistry Support Academy. Through our on-site training, virtual coaching, and twelve-week development programs, we help dental teams build confidence in the conversations that matter most. Because dentistry is about more than teeth. It's about people, and people deserve teams that know how to communicate well.

And before I let you go, it's time for what I always call our That's Good moment. And if you're new around here, it's where we take everything we talked about, and we pull out the lesson that I hope sticks with you long after this episode ends. So, here's today's That's Good moment.

An angry patient is rarely the beginning of the story. They're usually the middle or the end of it. The frustration you see today often started weeks Sometimes it started with a phone call or an assumption or a conversation that felt clear to the team, but it wasn't clear to the or because a good employee was moving too fast, or because everyone assumed understanding instead of verifying it That's good to know.

Because if that's true, then we have more control than we think. You see, we can't control every patient. We can't control every reaction or every circumstance, but we can control how clearly, we communicate. We can control how well we prepare our teams and how often we check for understanding and whether we're creating confidence or confusion.

And when we focus on those things, something interesting really does happen. The patient experience improves, treatment acceptance improves, trust improves, team confidence, it gets better. The practice is stronger, and not because it became perfect, but because it became intentional, and I think that's really good.

 Before we end today's episode, I want to take a moment to thank you. This year, No Silver Spoons was honored by Phoenix Magazine as the recipient of the 2026 Best of the Valley Award for the best podcast in Phoenix, Arizona. To Phoenix Magazine, thank you for this recognition. To every listener who nominated us, shared an episode, attended a training, worked with our team, supported Dentistry Support, Dentistry Support Academy, or No Silver Spoons, or simply continues showing up week after week, thank you.

This award means so much because it came from this community, and I am incredibly grateful for every single one of you. Thank you for being here, thank you for growing with us, and thank you for allowing me to be part of your journey. Until next episode, remember, there are no silver spoons. There is just the work we choose to do every day to become a little bit better than we 📍 were yesterday.

I'll catch you on the next episode