“We have a patient who sometimes ‘misbehaves’ during visits by either playing practical jokes on the staff or making inappropriate sexual and politically incorrect comments. What are the steps we should take up to and including dismissal?”

As the employer, you are shouldered with the responsibility to provide a work environment that is safe and free of discrimination, intimidation, and hostility. If you witness behavior first-hand that is unacceptable from a patient, the best scenario is to approach the patient immediately and ask that this behavior not continue as you feel it is inappropriate. If a member of your team brings the behavior to your attention, then you must provide direction and take action to correct the problem. In today’s article, I’ll provide suggestions to handle this appropriately.

People have different thresholds of tolerance. What might seem a bit funny to one may be intolerable to another. What might seem acceptable to some may be offensive to others. For instance, a highly recognized sports magazine publishes a swimsuit edition each year where bikini clad women are photographed in exotic locations. The issue appeals to some men (and some women), yet is scorned by some women (and some men). If a patient were to bring this into the office and use it as a basis of conversation regarding sexuality, a person may be offended.

Another example may be a person who comes to the office and recites a joke that has sexual or inappropriate implications. Some may be offended by this conduct; others find it amusing. There are venues for blue comedy or offhand remarks such as comedy clubs. However, a workplace is just that, a place to work and provide services. And again, as the employer, you must make certain that the workplace is safe and free of harassment, intimidation, and discrimination.

In particular to the question posed for this article, harassment is a form of discrimination that violates Title VII of the Civil Rights Act of 1964. Work Environment harassment occurs when unwelcome comments or conduct based on sex or race interferes with an employee’s work performance or creates an intimidating, hostile or offensive work environment.

Anyone might commit this type of harassment such as a co-worker, or non-employee, such as a contractor, vendor, guest, or even a patient of record. The victim can be anyone affected by the conduct, not just the individual at whom the offensive conduct is directed.

Harassment in today’s day and age has become broad-based. Some examples include but are not limited to:

  • telling sexual or lewd jokes;
  • leering;
  • touching in a way that makes the person uncomfortable such as patting, pinching, or intentional brushing against another’s body;
  • making offensive remarks about looks, clothing, or body parts;
  • use of racially derogatory words, phrases, or epithets;
  • making disparaging remarks about an individual’s gender or race;
  • negative comments about an employee’s religious beliefs (or lack of religious beliefs;
  • negative comments regarding an employee’s age;
  • sending, forwarding or soliciting sexually suggestive letters, notes, emails, or images; and
  • derogatory or intimidating references to a person’s mental or physical impairment.

When an event occurs that creates unease in the office, the first step to take is to act immediately. Bring the team together at the first possible moment where patient services are not interrupted. This may be right before a lunch break, or at the end of the day before anyone leaves the office to go home. Talk about what happened, and then review the office’s policy regarding what is considered harassment. Every person in the office should know what is considered inappropriate behavior.

It is advisable to have a strong, enforceable policy prohibiting harassment, sexual harassment, sexual discrimination, and inappropriate behavior. This policy should be contained in the office’s Employee or Personnel Policy Manual. A signed acknowledgement form stating the employee has read and understands the office’s policies should be included in each employee’s personnel file.

On some rare occasions, the guest or patient may not be entirely at fault. Try to discern if employee actions encouraged the misbehavior from the patient, without singling out team-members. If you have determined it was a team-member’s encouragement and dismissed it originally as just teasing, that was a mistake. The correct approach is to take the employee aside and discuss the issue in private. Come to an agreement on policy and how these situations are not tolerated. Agree to move forward in a positive light agreeing that events like these are avoided in the future.

To provide a bit of guidance regarding how an employee manual would stipulate the office’s policy on Sexual Harassment, consider the following:

Sexual Harassment:

The employer is committed to providing a work environment free of discrimina­tion. In keeping with this commitment, the employer maintains a strict policy prohibiting sexual harassment. This policy applies to all employer agents and employees, including management. Sexual harassment includes: flirtations, touching, propositions, verbal abuse of a sexual nature, graphic or suggestive comments about an individual’s dress or body or actual or perceived sexual orientation, the display of sexually suggestive objects or pictures, including nude photographs.

Sexual harassment also includes, but is not limited to unwanted sexual advances and requests for sexual favors where either (1) submission to such conduct is made an explicit or implicit term or condition of employment; (2) sub­mission to or rejection of such conduct by an individual is used as the basis for employment decisions affecting such individual; or (3) such conduct has the purpose or effect of substantially interfering with an individual’s work perfor­mance or creating an intimidating, hostile, or offensive working environment. Employees who violate this policy are subject to disciplinary action, including dismissal.

Any incident of harassment, including work-related harassment between employees, patients, or any other persons, should be reported immediately to the employer and/or to the designated individual. Employees will be given the name and or title of the individual so selected. A prompt investiga­tion will be conducted as discreetly as possible. Obviously, no employee reporting any such harassment will be subject to any sort of retaliatory action. Any employee accused of prohibited conduct will have the opportunity to explain the conduct in question. In the case of our employees, if harassment is proven, the offender will be disciplined, up to and including termination. It is the responsibility of every employee to conscientiously follow this policy.


Inappropriate behavior between co-workers, employers & workers, vendors, and patients may happen. Discuss with your team how you will handle this issue. Establish a policy that is professional, sensible, and in line with your dental practice’s fundamental principles. Regardless of how patients conduct themselves, your team must know the office’s policies and behave in a responsible, professional manner within the work environment.

Next Month:
How to appropriately dismiss patients from the practice.