a patient threatened to hit me, leadership won’t meet with me, and more

It’s five answers to five questions. Here we go…

1. A patient threatened to hit me

I work as a dental hygienist. I see most patients several times a year and build a relationship with them while providing their care. I love my job and especially love winning over anxious patients who are worried about pain or have had previous bad experiences. I work hard to make sure my patients are comfortable.

Today I had a new patient who was very nervous. At the beginning of the appointment, they expressed how sensitive they are during dental visits and said, “I will scream if I you hurt me.” I 100% understand that anxiety often looks like rudeness, and I spent several minutes discussing options to make the visit as comfortable as possible, we settled on a plan, I applied a desensitizer, and proceeded to clean their teeth. The patient said how easy the cleaning was and that it didn’t hurt at all. Victory! It was time for the next step and I explained what I had left to do, saying that this part should be comfortable and we were done with the hard part. They became very nervous again and repeated, “If you hurt me I will scream,” only this time adding, “And I will hit you.”

I am not okay with this. It is never acceptable to threaten to hit a health care worker who is doing their job, even in a joking way. It felt especially egregious after spending the previous 30 minutes doing everything I could to make the visit comfortable and had already successfully completed most of the visit without causing any pain.

In the moment, I was shocked and I didn’t say anything. I let a long silence fall between us and finished the appointment with minimal further conversation. I am disappointed that I let the comment slide and wish I had conveyed how unacceptable it was, but I was stumped on a response that was firm and clear without escalating the hostility. Hours later, what I came up with was, “It is never okay to threaten to hit me. I am working with you to make this visit as comfortable as I can. If you need to reschedule for another time or another provider, we can do that. But if I am going to finish your appointment today, I need for you to treat me with respect and kindness.” This feels too long and I’m not sure it’s quite right. I’ve thought about some simpler options such as “what a terrible thing to say to me” or “it is never okay to threaten to hit someone.” But those don’t seem like enough. Any thoughts on a script future me can use should this ever happen again?

How about this: “If that’s a real possibility, we should stop here. I can’t continue to treat you if I’m at risk of being hit. Would you prefer to reschedule for another time or with another provider?”

That doesn’t get into respect or kindness, but it does convey the essentials: what they just said was unacceptable enough to bring the appointment to a halt.

It also allows for the possibility that they didn’t mean to be disrespectful but truly were worried about having a physical reflex response. You don’t want to be hit whether it’s by reflex or design, so the response works either way.

2. Should I have told my boss my coworker was job-searching?

A couple of weeks ago, I was on a call with a teammate when they excused themselves to take another phone call, but didn’t mute themselves. I couldn’t hear everything that was said but I quite distinctly heard the caller say, “I see you’ve applied for the position of…,” after which my teammate quickly hung up the call.

I had already expressed to my manager my concerns about their performance and skills. After this call, my manager followed up on this, and I reiterated my thoughts. However, I didn’t mention what I had heard on the phone.

I then went on leave a couple of weeks, and when I came back, my teammate had resigned. Should I have told my manager that I had heard my teammate take a phone call about applying for different positions?

No. People deserve to be able to job search discreetly. It’s not something that rises to the level of “our manager needs to know this.” (In fact, in this case, it sounds like a good thing! Your coworker was in a job they weren’t doing well in, so they looked for and found a new one. That’s good for everyone.)

This does get murkier if you’re in a management position and learn someone is actively working on leaving while you’re planning a major new initiative around their hard-to-replace skills or you suspect they’d stay if they knew about the promotion being planned for them, or similar. Even then, though, it’s an ethical landmine and you need to remember employees can always be thinking about leaving (or have an amazing opportunity fall in their laps), whether you have advance knowledge of it or not. More on that here:

my employee is job-searching — should I tell my manager?

3. Top leadership won’t meet with me

How can I express concerns if top leadership won’t meet with me? I am a director at a nonprofit. There are three tiers of leadership above me. I feel heard by the first two tiers but not the top leadership. I brought my concerns about the workload, employee morale, and overall organization culture to Human Resources, and the VP stated they would attempt to set up a meeting with top leadership but I never heard back. That was two weeks ago and I sent a follow-up email.

They might not be willing to meet with you. If they’re not, then you probably need to be satisfied with having given your feedback to the two levels of management above you.

Whether it would be reasonable for them to decline to meet depends on things like the size of the staff overall, their investment in the topic you want to meet on, what else is competing for their time (a lot, usually), how much capital and influence you have (a long-time, highly valued employee will get a meeting with top leadership more easily than someone new or without much capital), and how much they trust the managers below them to flag feedback they need to hear. Since you’ve already met with two tiers of leadership above you, they could reasonably conclude that’s sufficient; large organizations have layers of management because the people at the top don’t have time to deal with every issue that arises. They might see it as squarely someone else’s job to meet with you on topic X, deal with anything that needs to be dealt with, and pass on to them anything they should be aware of.

That said, I wouldn’t conclude any of that after only two weeks. It can take time to get on a busy exec’s calendar if the issue isn’t time-sensitive. Give it another two weeks and then check back with HR. When you do, ask if the meeting is likely to happen or not; it’s better to know than to be strung along.

4. Should you tell someone they have an error on their resume?

We are hiring for a position on our team, and our manager has asked me and my coworker to review resumes and do short interviews with people who get past an initial interview with the manager.

We just received a resume from someone who says they are good at “building repertoire” with customers. It’s obvious they mean “building rapport.” This role requires very high attention to detail so it stands out.

They also mix tenses in their descriptions of their past jobs — “I do such and such” combined with “I did such and such” on the same former role. That one is not as noticeable and is likely because when they no longer had that job as the most current one, they never went back and updated all of the tenses.

He’s not the strongest candidate for this position but appears to be succeeding pretty well in his current role. I can tell because he’s an internal candidate and I know he received some not insignificant recognition for it. Part of me really wants to help him out by pointing out that he’s using the wrong word but would it be appropriate to do so? More embarrassing than helpful? Does it matter that he’s an internal candidate vs an outside one?

For an external candidate, I wouldn’t. You’ll see a ton of mistakes when you’re hiring and it’s not your role to be people’s job coach. But for an internal candidate — i.e., a coworker — sure. Wait until the process is over, and at that point, reach out and say, “By the way, I noticed these two things that I thought you would want to fix.” (Don’t do it mid-process though. Let things play out first.)

5. People with more accrued vacation have to take more mandatory vacation days

We received notice from management that due to poor forecasted results, mandatory vacations will be required for May, June, and July. Mandatory vacation applies to all employees with over three years of employment:
May – all employees over 100 hours accrued take one day vacation
June – all employees over 150 hours accrued take one day vacation
July – all employees over 200 hours accrued take three days vacation

Is the above legal? I understand the financial benefits, and those employees with the higher balances and over three years employment are probably in the higher end of the salary ranges. But this seems really unfair to the faithful, long-term employees — “thanks for sticking with us, now we’re going to stick it to you.”

Yes, it’s legal. Their reason for doing it is undoubtedly that unused vacation sitting on their books is a financial liability if they have to pay it out when people leave.

{ 558 comments… read them below }

  1. Stopped Using My Name*

    LW1, I would say “If you hit me, the appointment is over. You will have to reschedule to with someone else.” and follow through.

    1. Healthcare Manager*

      The moment someone feels unsafe is when you reschedule, not afterwards.

      If they hit them, then they’re banned from returning.

      1. HannahS*

        Completely agree. You don’t wait until someone is violent to end the interaction; it’s too late!

    2. Thinking*

      In Florida (at least when I was treated there) there were signs everywhere warning that it’s a felony to assault a health care worker. Since OP didn’t bring it up, probably not in their state, but waiting until after being assaulted is not the right move. The appointment ends when a threat is made, no exceptions.
      Don’t assume it will end with one blow either. Once out of control, the assailant might not stop.

      1. Seashell*

        I can’t imagine it’s legal to assault health care workers anywhere. Whether the situation in this case would constitute assault is a question for a prosecutor.

        1. WellRed*

          Sadly, I think in many cases, it’s a question for the health care workers boss. Read the book Nurse or others like it to see what a problem assault is.

          1. Daryush*

            Yes, in my experience, if you get attacked or threatened by a patient, leadership is going to put the blame on you for not successfully de-escalating the situation.

          2. Knittercubed*

            In a 40 year nursing career I was punched, bit, groped and had objects thrown at me. I had dozens of older men assume sexual gratification was covered under Medicare. No one tells you this stuff in nursing school.

        2. doreen*

          It’s not legal to assault a health care worker anywhere. But it’s not uncommon for the law to be written so that the status of the victim makes a difference in the charge so that striking a health care worker or a bus driver or a firefighter while they are working is a felony when the felony charge normally requires a serious physical injury.

          1. JustaTech*

            There’s also the issue of competence/capacity – if someone is clearly not fully conscious flails around and hits medical staff, the staff is still injured, but I don’t think the patient can be charged with assault because they weren’t awake.

            The harder thing is people who have had a serious brain injury and aren’t fully there, but aren’t totally out either, and do things like pinch people. It’s obviously intentional, but when the person doing it is not at adult (or even school-aged) mental capacity, it’s hard to argue that it is assault. (According to a person I know who did this while recovering from a brain injury the solution was oven mitts and a warning sign.)

            1. Butterfly Counter*

              When I worked in a hospital, it wasn’t unusual that older patients with dementia would “fight back” when given treatment. One older woman in particular was known for “coming up punching” as soon as she woke up.

            2. Reluctant Mezzo*

              Once as a nurse’s aide, I was told about a man who would get violent if he was surprised or awoken too abruptly. So we all stood at the doorway to his room and called to him till we were sure he was all the way awake, announced it was time for his vitals, and move slowly towards him to allow him to indicate he was ok (he was nonverbal, but his gestures were very informative).

        3. Hastily Blessed Fritos*

          Assault against anyone is of course always illegal, but in some jurisdictions simple assault (like punching someone) may be a misdemeanor rather than a felony, with carveouts for certain classes of victims (usually law enforcement).

          Caveat: IANAL.

          1. Michelle Smith*

            I’m a lawyer who practiced criminal law for nearly a decade and this is correct. In my state, law enforcement, children, elderly folks hurt by younger folks, cognitively disabled folks, and several other groups have special protections under the law such that what might be a misdemeanor assault against me would be a felony assault against them.

        4. mgguy*

          My wife is a bedside nurse at a childrens’ hospital.

          She has been slapped, punched, bitten, kicked, had things thrown at her, groped, and had bodily fluids/substances intentionally deposited on her or thrown at her. She has come home wearing hospital scrubs because what she had put on that morning was damaged beyond being decently wearable and/or had to be disposed of as biohazard waste. She’s been sent home from work with cuts/scrapes, black eyes, and concussions.

          It’s really a messed up and broken system, to say the least. Legally, they can file assault charges, but hospital adminstration “discourages” that. The only person she’s talked about doing it was someone who was backed into a corner and groped by a parent, not a patient(and even then there was some pushback).

          When my wife was pregnant, she was excused from her “duty to respond” or whatever they call it(basically that if a patient goes off the rails, anyone available is supposed to go in and help the situation) which pushed her out of the firing line for some things but still didn’t completely protect her. That was scary to think about what could happen-not that it’s good any time, but especially then.

          They have a lot of patients who have no medical reason to be there, but are there because there’s nowhere else for them to go. Many have behavioral issues and the like, and really should be in a mental/behavioral health facility, but spots in those are nearly impossible. Some of the motivation behind filing charges actually enrages me-often a record of assaults and the like are what are needed to get someone into a more appropriate facility, but her hospital would then lose the state money they get for those patients being there. Not only are they a danger to the staff and are taking up beds the hospital could otherwise put to good use, but at times they put other patients in danger.

          1. Reluctant Mezzo*

            I remember one elderly gentleman who stole my glasses and wouldn’t give them back for a half an hour. He later whacked someone with one of those metal Cardex things. We weren’t allowed to get rid of him, but I believe his medication was adjusted.

      2. Rainy*

        It’s the same where I live–as several people have said, it’s a carveout so that assaulting essential workers in the course of their normal duties carries a higher penalty than assaulting a regular citizen.

        Interestingly, here the protection expands to people seeking care or treatment, and that is stated clearly on those signs and posters. I have the right not to be assaulted, verbally or physically, while I am on premises at a doctor’s office, hospital, clinic, etc. I find it particularly interesting because a few years ago in the waiting room at my GP, an old guy tried to proselytize at me, and when I told him I wasn’t interested, he started getting really aggressive and he (and his carer daughter or DIL) were super shocked when I shouted down the waiting room to the reception desk “This man is bothering me!” and they took it seriously. His carer, after insulting me, ended up dragging him off while he tried to break away to continue “witnessing” to me, singing some hymn loudly the while.

        My insurance always sends out a survey after I have an appointment with any of my health care team and I specifically noted that I’d been verbally harassed in the waiting room by another patient and that the staff at reception had supported me.

      3. Paul Z*

        …. surely it’s a felony to assault people who aren’t health care workers, too? Like, everywhere?

        1. Rainy*

          The least severe form of assault is usually charged as a misdemeanor, at least in my state.

        2. Michelle Smith*

          No, that is incorrect. There are misdemeanor assault charges in many jurisdictions, including where I live. Often the differentiating factor is the level of injury, but not always. I remember a couple of cases from my time in criminal law (not my cases, but colleagues’ cases) where it was only a misdemeanor because it was a single punch, despite the fact that that single punch resulted in an orbital fracture and permanent vision loss. Your assumption is definitely very wrong. It may feel like it should be more serious legally to cause physical harm to someone else by hitting and biting them than say stealing a candy bar from Walgreens, but that’s not how the law works.

      4. Jellyfish Catcher*

        As a health care provider I’ve used this: “That is illegal, by both state and federal law. It’s best to end today’s appointment now.”
        There are also laws prohibiting patient abandonment- check with an attorney in some cases if needed, regarding dismissal.
        We have also used the above for sexual harassment behavior.

        Be prepared: have a code that alerts the office.

    3. Boof*

      I’m a medical provider and it’s 100% not ok to make any kind of threats, whatever the reason. That being said, as the OP points out, it’s usually coming out of a place of fear and anxiety, and there’s ways of making it clear that it is unacceptable that are more likely to deescalate the situation than others. Obviously what is desired is deescalation + never threatening again.
      So, this specific phrasing strikes me as likely to increase tensions, even if it’s a perfectly valid thing to say overall. I’d highly advise starting with empathy understanding, then finishing with the “but it’s not ok to threaten me or anyone”. So, I’d start with “It sounds like you’re really scared, and I totally understand that” (the opening/empathy/stating the problem you think is happening. Consider pausing to see if they say the problem is actually something else). “I’m on your side and want to help you get what you need [can mention that you hope you’ve been doing well so far in this scenario where you’ve already established some rapport]”. Give them a chance to answer. “One thing though, you just said you might hit me” (pause, see what they say to that). If they say “oh I was just joking, I’d never hit you” you can say something like “I’m glad to hear you didn’t mean it, but we have to take all comments seriously because we face a lot of problems. It’s like the airport, you can’t joke about bombs on the airport; you can’t joke about hitting or violence with your care.” (see what they say to that). MOST of the time that will diffuse the situation. If someone actually doubles down and doesn’t agree to never make such comments again, or if they keep doing it despite saying they understand, they need a behavior management plan, and eventually firing if they don’t stop (he management plan outlines what they will be fired over ie any actual physical violence, 2 or more comments about violence, swearing at staff, yelling at staff, etc)

        1. Boof*

          Thank you!!!! these are all tricks from the few but infinitely valuable advanced communication workshops :)

      1. Lenora Rose*

        This looks like a good script tree. (And short – definitely shorter than it first looks with the explanatory breakdown)

      2. JustaTech*

        This is also really good because it gives the patient the space to say something like “oh no, I don’t want to hit you! I’m just trying to warn you that I might startle hard and I want you to be prepared” – and from there I’d presume that the provider would talk about how the patient can ensure that they don’t flail their arms (for example).

        Because there’s no way for the provider to know if the statement was a “joke”, a threat, or a warning and request for help.

    4. purple monkey & bubblegum tree*

      I think that patients who attack medical staff should be banned from the practice, not allowed to reschedule with someone else.

      1. Zelda*

        But there’s a big difference between “attack a staffer” and “have a reflexive reaction to pain that could result in the staffer being *accidentally* struck.” Commenter elodieunderglass has some very insightful remarks below about what patient and staff can work on together to manage those reactions.

        Deliberately attacked someone -> will never set foot on these premises again.
        Warned staff of the possibility of a flail -> Stop the appointment for now, meet or have a call later to discuss ways to manage the reaction, resume medical procedure after that.

      2. Anon for this*

        It comes down to the idea that no one should be completely banned from receiving care, even if they lash out violently.

        1. also anon*

          Then maybe that care should be administered in a facility better equipped to restrain violent people. No one should be forced to provide care under threat of violence, unless they gave informed consent beforehand.

        2. Orv*

          I was once banned from a doctor practice for leaving a negative Google review. Medical offices can refuse service for any reason, just like any other business.

          1. Zelda*

            That is very ethically sketchy! Especially in a more rural area, where “so go to a different provider” just isn’t that easy.

      3. Alpacas Are Not Dairy Animals*

        This is a really tricky ethical question, especially when you get into physical startle reactions like Allison mentioned, or patients with dementia or other conditions that genuinely affect their impulse control and/or ability to understand what’s going on. Such people have a need for and right to medical care the same as anyone, and at the same time healthcare workers have a need and right to be safe the same as anyone else.

      4. Michelle Smith*

        Hitting and attacking are two different things though. I’ve hit a doctor before. I was under twilight anesthesia and do not remember the situation at all, but I apparently was not okay with them putting the endoscopy camera down my throat. Not only was I not banned from the practice for unknowingly being “combative” (that was the word used in my medical records) with the doctor, but he rescheduled and did the procedure himself on a different day…under general anesthesia this time. And I’ve never consented to twilight anesthesia for any procedures ever again. But how awful it would have been if I had been denied the medical care I needed because I hit someone when I was quite literally out of my mind on the drugs they gave me.

    5. Beth*

      I think the LW’s response — a long, long silence followed by cool civility — was a good one. It’s not as good as being able to state, clearly and at the time, some version of “That is not an acceptable thing to say”, but at least it’s likely to have conveyed some degree of social unacceptability.

      It’s incredibly hard to come up with just the right words when something awful and unprecedented happens. It’s good for the LW to want a script in case it happens again, although I certainly hope it never does.

      I also hope the LW tells her boss the details of what happened, and refuses to work with that patient again.

      1. me*

        +1 – it’s SO hard to know what to say in these situations, and I probably would have done the same. Afterwards, I would definitely loop in the boss and notate it in the patient’s file. Hopefully this won’t come up again, but you could also ask the boss if it does, how they would like to handle it, if it does happen in the future.

    6. Raisin Walking to the Moon*

      Why on earth would you suggest just a ruder version of Alison’s advice? What does this add?

    7. Princess Sparklepony*

      Yes, but I think this patient needs to be put on the do not book list.

      Also – there is a desensitizer that hygienists use? I never knew that.

  2. anon2*

    LW1, I don’t read that as a threat. It’s information, about how the nervous system of a person with past dental trauma will respond if that trauma is repeated, and about how essential it is that you not inflict pain or retraumatize them, for both your safety.

    You spent time reassuring them, which is good, but clearly wasn’t enough yet for the next step in the process. You haven’t built trust enough yet for the patient to tell you the specifics of their past trauma. But they are giving you the information that you DO need at that point.

    1. Rose*

      I have massive trauma, medical and otherwise, and C-PTSD. I would never threaten physical violence, and I absolutely take any statement of “I will hit you” as a threat. People can still choose their words, even during a trauma response. Excusing threatening statements with ‘they didn’t actually mean that’ can end in all sorts of danger.

      1. tabloidtainted*

        You may not react a certain way, but other people might, and those people deserve our understanding. We don’t need to imply that people whose trauma causes them to exhibit socially unacceptable behaviors are just inherently lacking. We leave behind people who need help that way.

        1. Nodramalama*

          Someone’s trauma response does not trump the safety of health professionals. They are entitled to not continue an appointment if someone threatens them with violence.

          1. leif*

            This! LW1 absolutely gets to decide and hold their boundaries as a person and a provider.

            1. Chauncy Gardener*

              Agree! And I really don’t understand why, after having successfully gotten through the first part of the appointment, THEN the patient threatens to hit the OP. This was very strange to me.

              1. also anon*

                If you read Not Always Right and some of the Tales from subreddits, you’ll see there are far to many otherwise functional adults who actively seek out and enjoy opportunities to harass and threaten workers they perceive as appropriate targets for their fuckery.
                Super super common.

                1. mr.mathmadz*

                  While what you are describing is absolutely a real thing, please be aware that a pretty large chunk of NAR, AMITA, Tales, etc, are made up for karma/clout. If you start reading those subreddits regularly you start to notice running themes/writing styles and will recognize how many of those stories are clearly written by a small circle of people that craft stories designed to go viral.

                  Same for a lot of those tiktoks along the same lines, there’s even a fake airplane set people have used to stage BS “scenes” of bad customer behavior.

                  Obviously these things are believable because there is a LOT of bad customer behavior out there (I’ve worked in customer service, trust me I know)! But be reeeaally careful about consuming too much fake stuff and letting it convince you the more extreme end of bad customer behavior is more prevalent than it really is.

          2. Venus*

            Oh absolutely! The only subtlety is that they may not have meant it as a threat, rather as something they know has happened in the past when someone caused them pain. A bit like my childhood friend who couldn’t control himself and flailed when tickled, but in the OP’s case much worse as it was likely trauma-based. I only mention my ticklish friend because if it can happen for something simple like that, it can happen as a reflex for pain too.

            This doesn’t change anything about Alison’s answer, because it’s perfect. Once the comment was made, whether threat or a comment about a known reaction, then the treatment needed to stop and OP needed to say what Alison wrote because her language is a great balance of assuming no malice while also being very clear on boundaries.

          3. MigraineMonth*

            I think it’s possible the patient wasn’t threatening (i.e. trying to intimidate/scare) and was instead trying to warn the OP about their reflexes or trauma response.

            In *either* case, it didn’t sound safe for the OP and they absolutely should end any appointment early if they don’t feel safe. In fact, it’s more important to end early if the patient is warning about a reflex or response they don’t have full control over.

        2. GythaOgden*

          No — when it escalates to that level, it’s not appropriate, whatever the underlying cause. I’ve suffered from GAD and I know what anxiety is like.

          Sometimes people can be unsympathetic, indeed, but normally people who work in an area like dentistry and healthcare are trained in bedside manner to the point where they do try to put the patient at ease as much as possible, as OP did. However, when it goes further into you threatening something, whatever the motivation or intention behind it, we have to do something, because many of us have faced a lot of real threats and violence in the past and we can’t take any chances. Most places in my experience of the UK health system (and in other contexts like post offices, railway stations, cafes etc), public and private, have posters up saying staff should be able to go about their day without physical or verbal abuse. If you’re an adult, you’re expected to be able to conduct yourself with respect for others whatever your triggers; it’s why we all laugh at ‘Karen’ videos on the internet. We don’t know the triggers behind those outbursts, and yeah, some are simply entitled people, but for others (even relatively privileged folk) the trigger could be real. Nevertheless, we expect people out in public and especially receiving services from others to be civil and polite and have coping mechanisms that don’t extend to threats against other people.

          Healthcare workers face this issue daily from all sorts of people. But having dealt with people who make threats, we don’t give them the benefit of the doubt due to an underlying condition — we have limits as human beings too. We have lives that mean we can’t necessarily take being abused and berated by someone, with mental health issues or anxiety or not. There has to be a point where the person’s anxious reflexes are not just accepted or tolerated and it’s made clear that, while you understand them, they can’t make you feel unsafe in your workplace.

          A lot of the time if you behave badly on the outside we’ll roll our eyes and just try and help you, and we know it’s the illness or anxiety that’s speaking. But we can’t discern whether a threat to hurt us is because you’re anxious and have no control over your mouth or whether you really want to hit us, and even if medicine is free where I am my plans for today don’t involve getting punched in the face and having to go to hospital for a broken nose.

          My dentist has been very good about anxiety. He allowed me to rebook an appointment and didn’t charge me after another issue was amplifying my normal nervousness about dental work. (My usual thoughts are — it’s half an hour of discomfort for months of benefit, and my current hygienist is an amazing coach along with being an awesome dentist.) But at a point where a patient is making threats, you have to take them seriously.

          1. Meg*

            This exactly. I’ve been screamed at and had curse words yelled in my ear as I tried to help someone with their dying pet. I’ve been told as a vet it’s my job to get bitten by their pet. None of that is acceptable and people seem to forget these caregivers can QUIT and you won’t have any of these services conveniently available to you. Just because I have a helping profession doesn’t also mean I don’t have CPTSD or GAD. I’m thisclose to quitting clinical vet med because of abusive clients and aggressive pets. People need to do better.

            1. No more Mrs. Nice Guy*

              And having been an RN, I agree 100%! And the thing with dental care, there are options for the fearful/anxious/traumatized patient. Mild sedation is offered in the area that I live in, I don’t know if LW has that option or not. But I agree with Allison’s reply, stop the treatment immediately, but with compassion. (I understand you are anxious, but…).

            2. Managing While Female*

              For sure. I really bristle at the “but so-and-so has trauma/anxiety/etc. etc. etc.” which just seems to excuse their behavior because it assumes that the person they’re acting out AGAINST doesn’t have any issues and can just be a punching bag. Yes, we should be understanding of other people’s situations and conditions, but everyone is still responsible for their actions even if those actions have an underlying reason behind them. If your trauma response is to hit people, others are well within their rights to say “I’m not willing to be hit.”

              1. GythaOgden*

                This is like the other great remarks about neurodivergent people not needing to follow norms that help them get on and work as a team with their colleagues and show their clients and customers respect, which is equally bad. Someone else put it well as ‘the soft bigotry of low expectations’.

              2. SnackAttack*

                Yup. Trauma is an explanation, not an excuse. I definitely empathize with those who have trauma or are neurodivergent, but if your affliction is causing harm to others, it’s on you to get help for it. I say this as someone with autism and ADHD.

          2. ferrina*


            If you think you might physically attack another person for providing a service you consented to, the responsibility is on you to remove yourself from that situation. Saying “I might hit you if you do this in a way I don’t like” doesn’t absolve you of anything.

            Mental health conditions are only an excuse if you are mentally incompetent enough that you cannot control your actions. If you are capable of understanding that violence is bad and capable of knowing that you may be triggered, then you are capable of removing yourself from the situation or setting up necessary precautions (and saying “fyi, I might hit you” is not a precaution). (note: if you are not being permitted to leave the situation, that’s another story. But in the letter, LW would have been fine if patient said “actually, I can’t do that”). Mental health conditions are not excuse to be violent. And it’s very possible for someone to have a mental health condition and also be a jerk.

        3. Awkwardness*

          Paraphrasing this:
          You may not [hit people], but other people might, and those people deserve our understanding.

          I tend to disagree.

          1. Sparkle goth*

            You’re assuming that the patient informing the dentist of this means they’ll do it consciously. Fight, flight, freeze and fawn are all legit reactions to being presented with a trauma trigger even if they are not rational or done consciously. Hell I have a colleague who nearly punched someone who startled them out of reflex.

            Which doesn’t mean the LW is wrong to feel unsafe upon being told they’ll get hit! Nor does it mean that LW has to sit there and take it (especially not because suddenly being hot may cause them to make a move that may injure the patient, depending on the instrument they’re holding at the time).

            I think Alison’s response is spot on, and if the patient needs more help or different help than LW can give that is also fine.

            1. AnonORama*

              Well, they could say I have a strong startle reflex, or sometimes I can’t control my arms flying out if something painful happens, or any other actual description. They don’t have to reveal their past traumas (or even if they have any), and that way maybe there’s a solution. If not, of course, the provider has every right to stop working with this patient.

        4. Andromeda*

          That doesn’t mean that the hygienist just needs to continue working on someone who might hit them — that sounds really frightening and potentially traumatising for them! I don’t think the phobic person is inherently dangerous or abusive or anything, but I do think the healthcare worker has every right to stop the session, or even stop treating that patient, and calmly say they can’t continue if the patient seriously thinks they’re going to lash out. It doesn’t have to be a punitive action, and there can be room there for starting treatment again if patient is at less risk of lashing out later down the line. But if the hygienist feels unsafe, they absolutely can say no. I’m not sure how possible it is for a hygienist to cause absolutely zero pain during treatment but I know I’d be thinking, “what if I cause zero pain but do something else that the anxious patient doesn’t expect and *that* causes them to reflex-lash out and hit me?”

          (Incidentally, it’s also possible that the patient was both being threatening *and* in the grip of a trauma response!)

        5. Annony*

          Trauma does not make “socially unacceptable behaviors” ok. If trauma causes a patient to hit the dental hygienist, they need to not schedule a tooth cleaning without a plan in place to mitigate that chance. They can’t just show up and announce they may turn violent.

          1. I'm just here for the cats!*

            I don’t think anyone is saying that the op or any other hygenist should be hit. I think we should come from a place of grace and understanding that some people have a lot of trauma and dentists or other medical porcedures can cause them to go into fight mode. It can be a reflex.
            What I would suggest is that the OP would have stopped the treatment and talked about options. Maybe bring in the dentist. If the person has this level of trauma then they may need medication or to be put under using something like laughing gas.

            1. GythaOgden*

              No, they aren’t, but they’re trotting the same old ‘soft bigotry of low expectations’ stuff that pervades some other discussions about things revolving around mental health we have here, and it’s not difficult for those of us who have successfully managed to control anxiety and its impulses to allow people to say that sort of stuff.

              We can tell when someone is saying something pretty ridiculous and unfair to the people who are giving them necessary services. They may not mean it that way, but just like the anxious person who can’t control their flailing limbs, it still hurts more people than it helps when they make statements like that.

          2. Alpacas Are Not Dairy Animals*

            Without them disclosing (or “announcing”) it first there’s no way to develop the plan; perhaps the next step in the conversation was for LW to share what their practice can do for people who need care and have startle reflexes.

            1. Grim*

              Yeah, but the appropriate time to bring that up is before the appointment starts. If I’m halfway through a procedure and a patient says, “by the way, if you cause me pain, it’s likely I will reflexively lash out and hit you” there’s really not much I can do at that point besides stop the procedure, or keep going and accept the risk of getting hit. The LW has already spent time talking about the procedure and verbally reassuring the patient, and the patient clearly still felt anxious. If the patient had disclosed their potentially violent startle reflex before the appointment, something else could have been done (e.g. administering a sedative), but it’s a bit late to “develop a plan” halfway through the appointment.

        6. Observer*

          We don’t need to imply that people whose trauma causes them to exhibit socially unacceptable behaviors

          The problem with this behavior is not that it is “socially unacceptable”. *That* word applies to using the wrong eating implement, wearing inappropriate clothes in many contexts, etc.

          When someone *threatens to hit someone* that is *bad and problematic* behavior. Maybe there is a reason for it, and maybe that person also deserves some sympathy. But the behavior is STILL bad.

        7. What's my name again*

          I can’t believe we’ve come to the point where we have to be “understanding” when being assaulted. WTF?

          1. Tobias Funke*

            Last month the right to expose oneself to a medical professional was defended vociferously. Reminds me of “don’t get so open minded your brains fall out.”

              1. Mary*

                “patients at my sleep clinic want to sleep naked, upgrading business flights and hotel rooms, and more”

                Do many people trying to justify flashing their medical personel. #Yikes

        8. Mango Freak*

          “You may not react a certain way, but other people might” is the right approach applied in the wrong direction! *You* might not be worried about getting assaulted at work, but other people might–and are.

          I don’t know where you’re seeing that anyone called anyone “inherently lacking.” If someone in a work situation says “I might hit you,” you can and likely should end the interaction so as not to face the possibility of violence.

          If this means that someone dealing with trauma has a harder time getting their teeth cleaned, well, yeah, trauma makes things harder, for everyone. There’s no solution that means nobody has to…look for a solution.

        9. Reebee*


          Please tell us about your experience in managing patients who threaten physical harm.

      2. Tiger Snake*

        Its important to remember we’re getting the words second hand though. Its possible they did pick their words carefully and its not coming through to us because that’s not the point LW1 remembers.

        I’m resistant to anaesthesia, and when I wake up from it, I tend to wake up in a panic. I discovered all this because the first time I went under, I woke up from an operation while still on the operating table. There was a tube in my mouth still – I thought I was choking. Because I was panicked and thought I was choking, but could sort-of see people around me (wasn’t wearing my glasses), my brain thought the best way to get their attention was to try grabbing someone’s arm.

        In other words: I slapped the anaesthetist.

        It was a weak slapped. I mostly missed. But still; it is a reaction I’ve had, and it’s important that my medical staff know so that they can account for it properly. I explain it to them exactly as I’ve explained it here, but you can bet 100% that when the nurses passed the message on, they’ve been joking with each other that “this one’s a hitter”.

        1. Hedgehog*

          1) I am so sorry this happened, that sounds purely awful.

          2) Yeah, I am sympathetic to this situation, if not the exact phrasing of OP’s patient. I sometimes have to undergo a procedure that is a little uncomfortable for most people but for whatever reason in me is *horrifically painful*. Obviously 100% of my concentration during it is aimed towards Cooperating With The Medical Personnel, but when you’re in that much pain, you’re gonna flail, and the people doing the procedure need to know this for their own safety.

          1. Rosemary*

            This is how I interpreted what the patient said in LW’s situation, not “I’m going to intentionally hit you if you hurt me.” Personally I think LW is overreacting. Absolutely ok for them to not want to continue if they are concerned they would be hit – be it a reflex or intentional; in that case they can say “if you think you will hit me we need to end this appointment now.” But to take it as a threat seems like a stretch.

            1. Knope Knope Knope*

              That’s how I read it too. And I agree that whether it was a threat or more of a warning about flailing Alison gave a good response.

            2. Venus*

              I don’t think LW is overreacting as they continued with the treatment, but I think some others are taking the most negative point of view possible.

              1. Helewise*

                I agree. I had to have real dental work done recently for the first time and found out that I don’t respond well to dental anesthesia. A safe work environment is non-negotiable, but I’m also very, very sympathetic to the patient here – reflexive physical responses to sudden pain aren’t always as easy to control as some commenters seem to think (and I say this as someone who has had unmedicated births and had an ER doc thinking sprained ankle rather than multiple displaced fractures – pain responses are weird).

              2. Panhandlerann*

                If someone says they may hit me, I’m going to err on the negative side, too, just in case.

                1. GythaOgden*

                  There are way too many times in any healthcare setting where someone saying they’re going to hit you mean it full well, and we generally don’t take the risk in finding out who’s bluffing and who isn’t.

                  Nor does your reason for punching me not hurt. Like John Scalzi’s short essay on stepping on someone’s toes: I don’t care if you stepped on my toe as an anxious reaction, you still need to get off my toe.

            3. Productivity Pigeon*

              Only the OP knows what kind of tone is what said with, and they felt threatened or at least uncomfortable. Let’s assume they know what they’re saying and not that they overreacted.

            4. Observer*

              This is how I interpreted what the patient said in LW’s situation, not “I’m going to intentionally hit you if you hurt me.

              I find this a fairly odd, and quite indefensible, interpretation. It’s not like the LW is newbie to the field and doesn’t know about this kind of thing. So the idea that they totally ignored that possibility and utterly misinterpreted what their patient said is not really credible.

              1. CowWhisperer*

                Except that experience doesn’t mean understanding of trauma or involuntary reactions. Or good with people.

                I work in education. Some experienced staff are great at de-escalation; others are more useless than a brand new teacher.

                The fact that the hygienist’s nose got bent out of shape that the anxious patient was still anxious – and explained what has happened before – at the end
                of the procedure doesn’t bode well.

                As many people pointed out, she could try asking what else the patient needs or working out a way the patient can end the procedure without hurting someone.

            5. LW1*

              Hi- LW1 here-
              This patient was rude and hostile throughout the entirety of the appointment. I interpreted it as anxiety and treated them with all the kindness and respect I would provide any other patient throughout the visit. When the patient told me they were nervous and have very sensitive teeth I sat down and talked through multiple approaches we could take for the visit. Together we came up with a strategy, I implemented it, and the patient told me it was working and they felt comfortable. I told them exactly how to get my attention if anything was uncomfortable, if they needed a break, or just had something to say. In fact, I ALWAYS tell ALL of my patients to raise their left hand and that I will stop immediately for any reason.
              I put the patients words in quotes because it is exactly what they said to me. I was not summarizing the gist of that they said- that was the direct quote. I also didn’t state whether they were “joking”, warning, or threatening, because I truly don’t know their intent- but to me it felt like a threat. They didn’t laugh after, they didn’t further explain. It was -“if you hurt me, I will hit you”. Particuarly in light of their treatment of me throughout the visit, I felt threatened.
              When a patient tells me that they might jump or flail, I talk through that with them. Truly, I worry for their own safety more than anything- when I have sharp instruments near their face, and particuarly under their gums, they can really be harmed by suddenly jerking or pulling on my arm.
              In this case, I was mostly done with the appointment, so I chose to wrap it up and finish the last few things. I did ask the patient if they wanted me to continue, and they agreed that they did. I was afraid of turning the rest of the visit into something rather adverarial because of how upset I was, and couldn’t come up with a way to tell them how inappropriate their comment was. However, I think it’s important that they (and all patients) understand that those words are never acceptable in a health care setting.
              If you see another comment I made, I did speak with my boss later that day, and this patient had made multiple similar statements to him as well. So this person clearly finds threatening harm is a way to feel some control over their fear- and they need to find another way to express it. We did also talk about offering this patient a sedative prior to any future appointments, should they come back to see me again.
              Finally, in response to someone else’s comment- I’ve been doing this about 30 years, and have developed a reputation as the “go to” person for anxious and sensitive patients. I genuinely LOVE working with the most difficult patients and consider it a success if they ever walk back through my door a second time. I tell these patients that my goal isn’t completing the scheduled treatment today, or even the next visit. My goal is to gain their trust, build the relationship, and get to the point where I can eventually provide the treatment that they need. Of course there are patients who don’t like me- and that’s ok too! I would rather that every patient finds the right fit for their providers.

              1. Memorable Name Here*

                LW1, thank you for all your efforts to make patients – including this alarming person – as comfortable as possible. I have a lifelong fear of dentists and anything dentist-adjacent, and finding a hygienist like you and a very calm, patient dentist has made a huge difference for me.

                Whatever is going on with this person, I don’t think you or any of your colleagues should have to treat someone who makes you feel unsafe. I hope this person is not allowed to return to your practice.

        2. UKDancer*

          I think people in theatre / anaesthetists expect people may not react very well as any anaesthesia can have unpredictable effects. I mean my grandmother said some really inappropriate things when she had a sedative. So I would imagine they’re well prepared, especially if someone mentions in advance that they’ve had previous experiences.

        3. Grim*

          I think that’s a little bit different, though. It’s not uncommon for people to be confused or even physically aggressive and belligerent when they first wake up from anaesthesia. In addition to being a potentially frightening and painful experience, it’s literally an altered state where people aren’t in control of their actions. People who work with immediately post-anaesthetic patients understand and account for this possibility, and it’s good that you know this is a reaction you might have to anaesthesia and can warn the staff in advance. That’s useful, actionable information about a medication side effect you’ve experienced before. It feels like a totally different order of magnitude for a patient at the dentist, where the dental hygienist has spent time reassuring them and trying to work with them and their anxieties, to say “if you cause me pain I will hit you”. That sounds like a threat, or at the very least a total abdication of your own agency. Even in a heightened state of anxiety, you still have some level of control over your actions, and a responsibility to mitigate the effects of your anxiety on other people. Like, if you seriously think that reflexively lashing out and hitting the dental hygienist is a real possibility, sit on your hands or something, or try and figure out a more constructive way of dealing with the problem. Don’t just say something that basically amounts to “if I hit you, it’s your fault” and leave it at that. It’s really not the dental hygienist’s job to stand there and accept the risk of being hit by an anxious patient.

          I’m also not really sure it adds much to the discussion to be theorising about whether the letter writer is inaccurately representing what the patient actually said. If LW says that the patient said “If you hurt me I will scream, and I will hit you”, I think we should trust them that that’s a reasonably accurate account of what happened.

          1. bamcheeks*

            For me it’s also about when you communicate that. “I just need to let you know that I’m very nervous, and a couple of times I’ve hit out a health professional” at the time of booking is useful information. The surgery can check with the professional whether this is something they are able to deal with, discuss booking a longer appointment so they can use a sedative, have another person in the room etc. In the middle of treatment, it’s not helpful or actionable advice. Even if this is said out of trauma or nervousness or as a joke, it’s absolutely appropriate for the health professional to =set a boundary with the patient, whether that’s terminating the appointment or the conversation that Alison suggested.

          2. kalli*

            The rule is more like ‘don’t theorise unless you’re also saying how that theory affects the advice you’re giving’.

            In this case, ‘if the patient was trying to say they have reflex actions to this particular stimulus but that context didn’t come through properly, whether because LW is summarising, the patient didn’t word it well, both, or something else, then an approach that’s a bit more circumspect would be appropriate, because ‘here is information you need’ is different to ‘i am threatening you’.’

            The advice is changed because the scenario is interpreted a different way. It isn’t ‘oh but LW should accommodate the patient by allowing themselves to be hit’ but ‘some people have physical reactions to pain, so if you can, perhaps don’t go straight to it being a threat’. LW might be able to pull in a second staff member, provide anaesthesia, or work on the other side for a bit – but if they go straight to ‘you threatened me! appointment over!’ then the patient who is really bad at handling pain goes away and maybe leaves a bad review, but certainly isn’t likely to return. Actual anaesthesiologists and recovery staff get trained on this, hygienists are often chucked in at the deep end. At the same time, if the patient doesn’t speak up then accommodations can’t be made, even the most simple ones that dental practices usually have to hand like providing a stress ball (redirecting the physical reflex) or turning on a TV (distraction).

            It’s not an easy thing on either side, and dental practices not training staff for various eventualities compounds the situation, especially when people have avoided dental work because of fear/pain/fear cycles and so the work does hurt and does take a while.

            None of this makes an actual threat okay, or requires a health care provider to tolerate it. It is simply an acknowledgement that the situation isn’t a 0-100 binary escalation and there are approaches that make sense at 25 that don’t at 75, and a flat out safety lecture and ending the appointment is warranted at 100 but maybe can be avoided at 40.

          3. Anesthetist*

            Anesthetist here and your explanation hit the nail on the head. People aren’t fully in control after receiving their anesthesia meds (that’s the whole point! You don’t want to be wide awake and sober during your procedure if you’re getting sedation or general anesthesia!) and these are common responses (although not in the majority of patients). Knowing this is useful for management- both in terms of staff being next to the pt for emergence to safely restrain the pt and keep them from falling, and because it changes the meds we use and how we wake them up. (Note that everything we do or give inherently carry risks and benefits, and we try to make choices where the benefits outweigh the risks- that’s why we don’t preemptively treat every patient as if they’ll have emergence delirium.)

            A dental hygienist cleaning in the office, awake, under local anesthetic only for an adult who is responsible for their own decisions is a completely different situation. Those patients are awake, alert, and in a state where they’re capable of responding to commands. If a patient cannot undergo dental procedures without undergoing general anesthesia (GA), then they need to schedule it with someone who has OR privileges and can do it under GA. This is often done for peds dental procedures, for adults with developmental disabilities, or for people who need extensive dental work.

          4. ferrina*

            Agree with all of this.

            All other factors aside, there’s a big difference between an unanticipated reaction and an anticipated reaction. Tiger Snake, you had no idea that you would react to anesthesia that way. Now that you know, you take the precaution of warning the staff and following their recommendations (that will keep both them and you safe).
            The patient 1) anticipated the reaction well enough to say “I will hit you”. This might mean that the patient was choosing to hit LW, or that patient had a known involuntary reaction where they would hit the provide, we don’t know, but either way 2) the patient did not have a conversation about precautions to protect the provider. If they thought that they would genuinely hit the provider, they needed to have a genuine conversation about how LW would not be in danger of being hit. (Bring a friend to hold their hand? not do part of the cleaning?) Saying “fyi, I might hit you” is not the way.

            1. CowWhisperer*

              Yes – but the provider also needs to work with the patient to have that conversation. The LW is highly focused on her technical skills – but she doesn’t mention talking with the patient about what the patient needs to feel safe.

              The LW has far more power – and is far more comfortable – with dental procedures than a severely anxious patient. I wish the patient phrased it better – but I’m equally disappointed in the LW’s rather blase comment that her use of painkillers was perfect and the implication that the patient was ungrateful.

              1. Dorothea Vincy*

                But it’s up to that patient to have that conversation with the provider beforehand, not just bring it up as a threat (and it was a threat! Telling someone you will hit them is a threat!) in the middle of the interaction. The idea that the LW is to blame and, what, deserves to be threatened? Deserves to be hit? because she wasn’t “perfect” and should somehow have anticipated that the patient would threaten to hit her beforehand without the patient needing to say anything because OMG trauma! is disgusting.

                1. Humble Schoolmarm*

                  I work in education (obviously) and de-escalation and trauma is something that we’re working on a lot. On one hand, I think it’s wonderful that we’re learning about why kids behave as they do and how to cut things off at the pass before anyone gets hurt. The trouble with it is that there is a very, very fine line between talking about how you could have done things differently to make a situation end well for everyone and victim blaming (well, if you hadn’t told volatile kid to follow the rules….).
                  The problem is, that this semi-victim blaming mentality (or at least, that’s how it comes off) leaves a lot of care providers feeling like they have to be perfect in all forms of communication (including body language) and generally just sit there and take any and all threatening, mean or abusive behaviour. You can have sympathy for the patient till the cows come home, but it doesn’t change the burn-out or the repeated traumas that add up. We have to find a way to be understanding and supportive of the needs of patients and students without allowing the professionals to be repeatedly harmed and I don’t think we’re there yet.

              2. LW1*

                You are interpreting something very different than what happened, and what I wrote happened. Since I couldn’t write a novel, I didn’t go into all of the specific ways that I empowered, provided comfort, and gave opportunities for the patient to participate in the visit and/or to stop the visit at any time. But please rest assured, I did. I’m not sure where in my comment you insinuate that my use of painkillers was perfect, unless it’s from the patients own comment that the visit so far had been easy and hadn’t hurt at all. I reported exactly what they told me to help provide context by why I was so surprised by what they said a few moments later. I was not making assumptions about their comfort, I was believing what they said. Furthermore, I said the patient was acting egregiously, not ungratefully. To tell me that I had done a good job keeping them comfortable, but then to immediately follow that up by implying that should that change, they will hit me seems pretty extremely and conspicuously bad to me. I don’t need a patient to be grateful, but I won’t allow them to threaten to harm me for doing my job.

              3. Grim*

                The OP literally said “I love my job and especially love winning over anxious patients who are worried about pain or have had previous bad experiences. I work hard to make sure my patients are comfortable. […] I spent several minutes discussing options to make the visit as comfortable as possible, we settled on a plan, I applied a desensitizer, and proceeded to clean their teeth.”

                I have no idea how that seems to have come across as “she doesn’t mention talking with the patient about what the patient needs to feel safe” to so many people. They had a conversation and discussed a plan. If the patient actually wanted to discuss their startle reflex in a good faith, constructive way, that would have been the time to bring it up. Not once the procedure is already underway. I think that’s why so many people are perceiving “I will hit you” as a threat, rather than a value neutral attempt at providing information, because it’s kind of an ultimatum. At that point, the LW’s options are pretty much limited to stopping the appointment altogether or continuing and letting the patient (potentially) hit them.

          5. Tiger Snake*

            Your missing my point. I’m not saying this is the same as what is happening in LW1’s workplace.

            I am saying that I, as the patient, said the above, and what the medical practitioner’s heard and relayed to their peers was “This one’s a hitter.” We are getting the information about what specifically was said second hand. We are not hearing exactly what the patient said, we are hearing how LW1 interpreted it.

            And that means us talking about “its different to if the patient had used slightly different wording” is inherently not useful, because for all we know they did.

        4. KateM*

          I was once prepared for a surgery and one of nurses was putting some kind of little socks on my feet. I am very tickly but I supressed my reaction with all my might, keeping my feet still. It went all right with first sock which she got on at the first try but she took about five or six tries with the other and then I just couldn’t anymore, my foot started to twitch. I guess I hit her hand, and possibly it looked to her like I was trying to hit her face with my foot, at least her expression when she stared at me… Thankfully there was a second nurse next to her who realized what must have happened and asked if I was tickly.

        5. WellRed*

          That’s awful and also a lot different. Of course you panicked. Stuff of nightmares!

        6. Bast*

          It took me quite a few not so great dentists to find a good one who listens to me. I need a LOT of anesthesia for it to work. I have had dentists who did not listen, outright tell me, “stop being dramatic, you don’t really feel this, you’re just nervous” when I absolutely did feel it. A few times I’ve just grinned and tolerated it while being in pain, but one time I needed a root canal and I just couldn’t. The second they touched that root, I jumped straight up, flailing my arms in a reaction to what was an extreme amount of sudden, sharp pain. It was not something I consciously was trying to do nor was I trying to hurt anyone, but yes, I 100% felt the pain they stated that I could not be feeling and that was the result.

          1. RedheadAj*

            Are you a redhead/ginger? Studies have shown that lidocaine (common local anesthetic in dental work) is less effective in redheads. Other studies show that redheads may actually have a higher tolerance to pain, but may be more sensitive to temperature changes.

            1. Bast*

              I am not a redhead, but I have read about anesthesia having less of an effect on redheads and find it fascinating.

            2. Ace in the Hole*

              I’ve often wondered if the gene for this can be expressed even if the redhead genes are not.

              I’m extremely resistant to local anesthesia – the last time I had a procedure done it took 3 times the expected dose to even start getting me numb, I could still feel pain throughout the whole process, and it wore off in about a quarter of the expected time. I’m not a redhead but all five of my aunts/uncles are.

            3. kim*

              I’m not a redhead but lidocaine is less effective on me, and learning about that radically changed my dental experiences. It’s weird and it’s hard to explain because I don’t really understand how it works, it’s not an allergy, and it’s not that it doesn’t work at all, it just doesn’t work the way it’s supposed to. But I remind my dentist of it every single time I have a procedure – no lidocaine, right? I’m getting the other stuff?

              Also note it’s not just for dentistry, although that’s where it comes up the most for me. I’ve also had to ask for something different when, eg, getting stitches after I cut my hand. Any time the doctor says “I’m going to give you a local.”

          2. Risky Biscuits*

            When I had my wisdom teeth removed by an oral surgeon who only used local anesthesia, I and my regular dentist warned him repeatedly about my resistance to local anesthesia and how fast it wears off. On the last tooth, it was wearing off. I yelped and lifted my hand and started to lift his arm away. He said something like “don’t worry, you’re fine, other people haven’t been able to numb you but I numbed you.” And he put his arm on me to hold me down while his assistant grabbed my arm and he pulled the tooth out. It was very painful.
            So, at least saying “if you hurt me I will scream and I will hit you” gets the possibility of it hurting taken seriously. The problem for me is that no matter how much I tell doctors something will hurt me or is hurting me, they do not believe me, because it does not affect them.

            1. Bast*

              It’s fairly alarming how many people have been told they are not in pain when they alone are in the best position to know what they are feeling, or how they react/do not react to certain medications. I know how I react/do not react and while I have a fairly high pain tolerance, dental pain, in particular, just doesn’t hit the same as normal pain.

        7. allathian*

          Yikes, you experienced my worst nightmare! I’m so sorry you went through that.

          I’m 52 years old and I’ve never yet needed general anesthesia and I hope to keep it that way. I react well to local anesthetics, though.

          I’ve had a couple experiences of sleep paralysis and they were horrible enough for me.

      3. fhqwhgads*

        OP knows better than we do whether it sounded like a threat or just a statement of fact. Unfortunately, if the literal wording were just “I will hit you” without tone, we can’t really tell from reading. There have been letters before from people who explain they have a startle response (or whatever response) and do response to certain things by flailing or hitting or whatever, and it’s reflex. That doesn’t make it OK to hit a healthcare worker, but the people pointing out that it’s ambiguous (to us as readers) whether this person was threatening violence vs saying “by the way when X happens, my body does Y and I can’t necessarily stop it”. You might be thinking, “well surely the patient would’ve spelled that out more clearly if that’s what they meant” but people are often really bad at that.
        Which is why Alison’s suggestion is spot on: because it addresses the situation either way.

    2. Ask a Manager* Post author

      If the patient seriously thinks they might hit a health care provider, they need to end the appointment and seek more specialized assistance to help figure out how to safely get the care they need.

      1. Harper the Other One*

        I thought your suggested response of saying “if you’re feeling like hitting me is a possibility we should end the appointment here” was perfect. It both acknowledges the anxiety and protects the employee! Plus, in terms of the patient’s perspective, far better to leave off at a positive moment (we got all of X done and it wasn’t so bad!)

        1. Simona*

          Indeed, and there are practices that will give sedatives and other things for people with this kind of reaction.

        2. HonorBox*

          Exactly this. The provider is recognizing what is said and acknowledging it in a way that doesn’t pass judgement but also protects their own safety.

        3. Festively Dressed Earl*

          Agreed. It simultaneously lets the patient know not to joke about hitting staff (if they meant they’d intentionally hit LW) and gives the patient an opening to disclose a tendency to hit as a pain reflex. If LW’s office has that information, they can plan to keep staff safe from involuntary reactions without needing to turn away a patient.

      2. WantonSeedStitch*

        Yeah, this. If you’re concerned that you might freak out enough to hit the person providing your care, you need to discuss that up front and talk about what options there are to keep everyone safe. This person sounds like they really need sedation dentistry, both for their own sake and the sake of the providers.

    3. Nodramalama*

      Uhhh sorry no. If someone is threatening to hurt them, they can end the appointment. Just because they’re in health care doesn’t mean patients can do whatever they want and they have to put up with it

    4. AcademiaNut*

      At a basic level, it doesn’t actually matter if “I will hit you” is intended as a malicious threat, or they’re explaining an involuntary response due to prior trauma. What matters is that they’ve told the LW that it’s not safe for them to continue treatment.

      They need a level of treatment that’s beyond what the LW is offering, as she can’t guarantee that there won’t be any pain, Sometimes dental treatment is painful, or uncomfortable in a way that is interpreted as pain, no matter how kind and careful the hygienist is. If that’s going to result in the hygienist being assaulted, then other, more specialized arrangements need to be made.

      1. Irish Teacher.*

        Yes. Given the context, I would read it more as a warning about a reflex action than as an “I will beat you up” typed threat too, but that doesn’t change the fact that the hygienist has the right to go about her day with being assaulted or even feeling like she is at imminent risk of being assaulted, even if it isn’t intentional. This is why I really like Alison’s script. It doesn’t make any assumptions about what the patient means but simply makes it clear that if there is any risk of the hygienist being hit, the appointment has to end.

    5. ElleKat*

      “I’m not threatening you, I’m stating a fact” is a pretty classic threat!

      If it’s ok for the patient to hit (or threaten to hit) due to their nervous system response, then it would also be ok for LW1 to have their own nervous system response if they get hit for no reason? Past trauma is no excuse for abusive behavior.

      Fawning over an abusive person (which someone making threats of violence definitely is) will not make them see how much you care and stop abusing you, they’ll just see their threats “work” and they’ll do it again.

      1. tabloidtainted*

        A single statement doesn’t make someone “abusive,” and we don’t have enough information or context to decide that this person was manipulating LW and trying to abuse them.

        1. Jam Today*

          If a person knows they are a danger to people around them, its their responsibility to find help to deal with that. Its absolutely not anyone else’s responsibility to parse the difference between being punched intentionally or reflexively, and be OK with the second because “past trauma” or whatever.

          1. Managing While Female*

            Yes, precisely. Past trauma can explain the ‘why’ but it doesn’t excuse the behavior. In fact, most people who abuse others were once abused themselves — that doesn’t excuse continuing a cycle of abuse. I’m not accusing the patient of being an abuser, but once you’re an adult you accept responsibility for your actions, whether they were intentional or not.

      2. Hyaline*

        Except in this case it may not be an intentional act of violence but a reflex, no different from “just warning you, I have a strong gag reflex and might throw up.” That’s not abuse, it’s warning someone about a physical reaction outside your control.

        1. Jam Today*

          If you cannot control your reflexes that harm other people AND YOU PURPOSEFULLY PUT YOURSELF IN THAT SITUATION then you are at best completely unconcerned with the welfare of the people around you, and more likely believe that it is other people’s responsibility to absorb your failure to manage your reactions. Either way, you do not belong in a public setting.

          1. Hyaline*

            And the hygienist has every right to and should stop the appointment once they have this information. But they should treat it as information—not as a condemnation of the person (calling them “abusive” is unnecessary and untrue).

            1. GythaOgden*

              Can I just ask how many times you’ve provided a medical service or been a medical receptionist? A lot of people here with actual experience of the field are saying that we see enough actual cases of abusive patients to not really split hairs when it comes to someone taking that tack.

              It’s unfortunate, because while this site can be very kind where mental health is involved, there’s a point where the arguments start to exclude the very real perspectives of people that kind of behaviour hurts, whether it’s from the grumpy receptionist who won’t deal with certain patients or the patient who tells her provider she’s liable to hit her. It’s pretty bizarre that we bend over backwards to excuse the person behaving problematically and blame their victim for being in the wrong place at the wrong time.

              Neither a provider being belligerent or a patient having such hair trigger anxiety that they know what they might do without taking any responsibility on themselves to do something about it are any less of a human being for behaving badly in public. But they do need to ensure that behaviour does not end up upsetting others who have stakes in their behaviour towards them.

              And yeah, I’m not sure whether you’ve been in healthcare but I think you’d understand that abusive is as abusive does. It’s where your desire to be fair to the person with least supposed ‘privilege’ clashes with the general rights of those providing care not to be randomly thumped by someone in their care, or for someone not to be discriminated against (as the grumpy employee was doing in the previous letter) when going to see their doctor.

              I worked really hard over the ten years I was in healthcare reception to make sure patients were safe and comfortable and looked after. Despite not dealing with them directly, I bent over backwards despite arduous personal circumstances to be kind and compassionate in the face of multiple abusive people who were hiding their behaviour behind their mental health conditions. I could be an ass too when I was anxious or in the throes of a delusion, so I got help to try and sort out that part of me in order to be more successful at holding down a job and a relationship than I had been when I was at my worst.

              So yeah, it’s abuse. It’s not the way it often manifests, but healthcare is a field where you will at some point encounter people who aren’t under control of their anxiety or whatever. And it always comes off like you don’t actually care about the real people that get hurt because you’re fixated on ‘omg they have poor mental health don’t stigmatise’ for more abstract reasons.

              It gets really weird over here to watch a common problem in the medical field get dismissed like this.

              1. Lexi Vipond*

                I don’t think this is specifically about medicine, it’s a general terminology question about whether the word ‘abusive’ should be restricted to behaviour which was deliberately intended to hurt or control another person.

                It doesn’t mean that hurting another person unintentionally isn’t WRONG, it’s just that under that naming system it wouldn’t be called abuse, in the same way that not all deaths are called murder.

    6. tabloidtainted*

      I agree with your assessment, but I also think it’s not appropriate to say something like that to an average dentist, especially when you’re already in the middle of treatment. Patients whose trauma response involves lashing out should see a trauma-informed dentist and discuss trauma responses *before* getting in the chair. LW should feel comfortable stopping treatment and asking the patient to clarify what they mean and/or refer them to a more appropriate dentist.

      1. Allonge*

        Yes, this. If someone knows they have uncontrollable, violent reponses to a treatment, they have my sympathies, but that’s on them to discuss much earlier on the process – at the time of the scheduling or when selecting the treating doctor or other medical professional.

        It’s also (probably) easier to do without sounding like a threat when you are not right next to all the medical equipment and within a minute or two of the treatment actually starting, which I guess is already pretty triggering.

        And no, making it a personal threat is never ok.

        1. Anonychick*

          “ Yes, this. If someone knows they have uncontrollable, violent reponses to a treatment, they have my sympathies, but that’s on them to discuss much earlier on the process – at the time of the scheduling or when selecting the treating doctor or other medical professional.”

          Yes, exactly. I have sensory issues that mean I startle and flail at things most people wouldn’t even notice. The way I deal with that is this:

          – When searching for a new dentist, I focus on those who use words like “inclusive” (even though that often means nothing)
          – When calling to ask about an appointment with a new dentist, I ask questions: “Does [doc] have experience treating autistic patients? Is [doc] comfortable with my needing light sedation (nitrous oxide) for even routine cleanings?”
          – At the beginning of my first appointment with a new provider, I remind the office upon checking in that I need gas. If I get any pushback, I leave.
          – During my appointment, I consistently express my needs, for my safety AND the provider’s: “I think we need to up the gas a little bit: I’m worried I’m going to accidentally kick you with the way my legs are twitching.” This phrasing is important: I am making it clear that I am not threatening to kick the provider, but rather seeing the possibility of an unintentional-but-negative outcome and taking steps to avoid it.

          TL;DR: people can’t control their reflexes (by definition; that’s what reflexes are!), but they CAN control how they behave before and after they kick in. The patient was in the wrong, and it’s fine for LW to push back!

          1. LW1*

            Anonychick, you are amazing. Come be my patient. I would LOVE to take care of you!

            1. GythaOgden*

              My hygienist is awesome (she’s a great coach, which is what I really needed, who explained to me what was happening scientifically — my kind of language — and helped give me tips to reverse the problematic dental issues I’d had while struggling mentally myself), but I wouldn’t mind alternating with you once in a while. If you fancy moving to my home town in England, I might not have to go so far to get a good hygienist, as mine works where I used to be based in person, not where I actually live. But I keep going with her because she’s really revolutionised the way I see my oral health.

              Her only problem is that she starts an interesting conversation (often about things in the news or her/my travels abroad) as she is putting her tools into my mouth. I’ve learned a rather intricate sign language to be able to talk to her without being able to speak — and without getting poked in the wrong place.

      2. Hyaline*

        This. Also, the LW should feel free to involve the dentist to discuss options and referrals with the patient once the patient disclosed that they weren’t able to control their reactions reliably.

        1. LW1*

          I did speak to my dentist later in the day. Honestly- I wasn’t particularly worried about him, I knew he’d be on my side. But interestingly, he said the patient had previously made several similar comments to him! He recognized that he had failed by not setting firmer boundaries with this person and apologized to me for his role in this! He will be speaking to the patient face to face when they return to see him soon and setting very clear expectation for future visits.

      3. HonorBox*

        Agreed. While not the same thing at all, I just sat next to a woman on an airplane who said, “I apologize if I snore. Please feel free to elbow me if I do.” It set the table in advance and didn’t leave me wondering what to do. If the patient knows that their body’s response is yelling or physically hitting, that’s something that needs to be presented early on so the provider can make a decision about how to proceed.

        1. GythaOgden*

          Snoring is not causing someone else actual harm though, and warning me that you’re going to punch me is way more aggressive than warning me you might snore.

    7. MK*

      If your trauma makes it likely that you will hit your dentist if they hurt you, you probably need to learn to live with bad teeth. Dental workers don’t hurt patients put of carelessness, it happens because it is sometimes inevitable due to the nature of the work. And it’s incredibly inappropriate to suggest that if the patient had hurt the OP, it would be OP’s fault for retraumatizing them.

      1. Beth**

        It’s possible to get dental treatment under sedation. I have a relative with severe dental phobia (panic attacks etc.) and they have to be sedated for dental treatment, which can only be done in specialist clinics.

        There are options available but the patient has to seek them out. They should not be putting their provider at risk.

      2. WS*

        If your trauma makes it likely that you will hit your dentist if they hurt you, you probably need to learn to live with bad teeth.

        No! There are lots of ways to get help for this – absolutely they should not go to the dentist if they’re a risk for hurting a healthcare provider, but “live with bad teeth” is not the answer either. My parents both had dental trauma (though they dealt with this for years by never going to the dentist) and as a result were extremely careful to make sure we kids went to a very careful and caring dentist. When my dad got two front teeth knocked out playing sport and still refused to go to the dentist, he realised he needed help and got it.

        1. Harper the Other One*

          Yes, at minimum you should look for a dentist who offers sedation as an option for ALL procedures (although be forewarned that insurance will almost always not cover optional sedation), but many areas also have dentists that specialize in working with folks with dental anxiety.

          1. NotSoRecentlyRetired*

            I just learned that sedation for my tooth extraction to prepare for an implant would cost $400+, in addition to the $4000+ that I’m paying for the implant. This because I selected insurance this year which only covered basic cleaning & fillings. But this is still a lot less than if I had no insurance. FYI – I am in the USA. And I have natural red highlights in my hair, so I am more susceptible to pain.

        2. Grey Coder*

          Yes, there are specialist dentists who work with patients who, for a variety of reasons, may not be able to control their movements.

        3. GrumpyPenguin*

          Yes, dentists specialized for this reason. Maybe ask your health care provider for a list of those dentists, most of them have those lists.

      3. Hastily Blessed Fritos*

        There are dentists who offer sedation. Dental phobia is fairly common, even if it doesn’t often rise to the level of panicked flailing (if that’s what’s going on here).

      4. Caramel & Cheddar*

        There are an increasing number of studies out there showing how oral health and other diseases are linked, so “live with bad teeth” really means “live with increased chances of heart disease / Alzheimer’s / etc.” There are lots of options for both patients and dentists to deal with this kind of fear/trauma, they don’t need to forfeit a crucial element of their healthcare because of it.

        1. Boof*

          It means first the violent impulse needs to be controlled, then the teeth addressed. There’s no scenario where health care workers need to put up with harm to themselves to prevent problems for their patients.

          1. Caramel & Cheddar*

            Yes, my comment doesn’t disagree with this. The point is that there are options between “It’s fine for patients to abuse healthcare workers” and “vulnerable patients have to just deal with having bad teeth.”

            1. Boof*

              Right, I just wanted to be clear that the priority has to be addressing the staff safety concern first.

      5. GrumpyPenguin*

        If you are having a physical reaction due to trauma/ panic attack/ epilepsie, you can’t control that, but you need to give context though. You can’t just anounce you’ll hit someone, that is clearly a threat, but telling your doctor you might react this way is different. It’s the wording and the tone that matters.
        Doctors refused me service/ kicked me out in middle of treatment because my body reacted and I couldn’t get treatment for my teeth for ten years before finding a dentist who would see me. We both worked hard to make it work and I’ve been there for 6 years. According to him, nobody should be forced to live with bad teeth.

        1. LW1*

          Good for you- I’m so glad that you were able to find a provider that could safely and comfortably care for your needs.

      6. Alpacas Are Not Dairy Animals*

        Lack of dental care literally kills people with a fair degree of frequency. No one needs to die because they didn’t phrase “I have a strong startle response and might need more sedation” in the most informed way possible.

        1. GrumpyPenguin*

          That’s true on one hand, but I also think a patient is responsible for their own body and their reactions. So if you know you might react in a certain way, anounce and explain it beforehand. It’s about clear communication from both sides. Not always easy, I admit.

    8. learnedthehardway*

      I think that Allison’s response is perfect – it addresses the safety of the situation, not the motivation.

      And that’s something important to consider – someone with a genuine phobia telling you that they may react violently is not threatening. Rather, they are informing you of information you need to know.

      One of my siblings was terrified of dogs, and in a panic because a dog approached them, flipped out and beat up my other sibling (who was older and bigger), when the older one didn’t “protect” the younger from the completely harmless animal. It was sheer panic.

      This is also the reason why in lifesaving courses, they teach you how to rescue someone without being harmed yourself – because the person is panicked. Eg. a drowning person will pull another person under in their panic and kill them – without meaning to do so.

      Phobias work the same way – it’s a fight/flight/freeze response, that defaults (in some people) to fight.

      1. Nodramalama*

        The fact that a threat might not be malicious does not mean it is not a threat. Telling someone if something happens you will hurt them is a threat of violence. Even if they are trying to be informative rather than intimidating, it is still a threat of violence.

        1. Jennifer @unchartedworlds*

          I think “threat” can be used in two different ways. One is a thing someone says or does intentionally to try to get an action or response from you. The other is more like “potential danger” (e.g. “threat of a storm”, “it was threatening to rain”, “inflation threatened to ruin our financial plans”).

          If the person only meant to be informative, it’s still a threat in the sense of potential negative outcome. I think people saying it isn’t a threat are talking about the first meaning, along the lines of “I am actively trying to exert power over you”. In the context of human beings, I think it usually does mean that.

          1. Allonge*

            So – you are not wrong, but it’s very much on the person, anxiety notwithstanding, to express themselves in a way that does not sound like a direct threat.

            Once ‘I will hit you’ is out there, it needs a LOT of context to be just informative and not to be treated as a physical threat.

      2. GythaOgden*

        Case in point: bird phobia guy. Your mental health does not give you the right to hurt others and face no consequences. It might be mitigating circumstances when it gets to a judicial process, but it’s not going to get you off.

          1. GythaOgden*

            Yeah, I wasn’t around for that thread but thanks for the correction. I think his consequences may well have been moral — the lady who got hurt obviously not wanting to be in contact with him and presumably other social repercussions that we weren’t aware of. I certainly wouldn’t have been on his side.

      3. What's my name again*

        The fact that you seem to think your little anecdote is totally fine is truly frightening.

        1. learnedthehardway*

          I mean – what do you do? Punish someone for panicking? That’s not going to help.

          If the OP’s client informed her she has a phobia and can be violent when confronted with their phobia, that gives her an opportunity to deal with the safety issue. It’s entirely appropriate to remove oneself from the situation, say that they cannot continue to provide care, offer to have a doctor provide a sedative before continuing, etc. etc. But it’s not fair to ascribe a motive other than pure panic to the person.

          1. Lightbourne Elite*

            Depending on the situation, yes? If someone beats me up as described above, I’m likely to press charges whether or not they were panicking. Or otherwise impose consequences like never allowing them around me again or, if they’re a client, refusing to work with them again.

            1. What's my name again*

              Agreed! What the heck? I feel like I’m in the Twilight Zone… “Oh well, they panicked and beat the crap out of me. No big deal.” Like WHAT. I would never be in their vicinity ever again, family or no.

            2. GythaOgden*

              Yeah. The health trust I worked for was responsible for a local mental health inpatient facility. The number of times someone was injured on the job was disturbing. People do inexcusable stuff for all sorts of reasons, but the end result is the same.

      4. Lightbourne Elite*

        The way you describe your sibling behaved in response to their phobia may be explained by their phobia but is also objectively unacceptable.

    9. frontlinER*

      Respectfully as a ER nurse who has been assaulted by patients, this is not an appropriate response to any medical procedure. If they consciously booked the appointment, they need to consciously prepare for the possibility that it may be uncomfortable. No one likes to be in my ED, but most people prepare themselves for pokes and prods. Same for dentistry. The OP needs to set clear boundaries and stick to them when the patient threatens violence like this.

      1. UKDancer*

        This so much. If you’re aware of your actions you shouldn’t be attacking the staff and should take measures to ensure you don’t. I’d give some grace to people coming around from anaesthesia or strong sedation who are often not aware of where they are or what they’re doing but otherwise I’d expect people as a minimum not to hit the staff.

    10. Tiny Soprano*

      I agree, though I don’t like how OP’s patient framed it, and I do think they should be more respectful to OP.

      I used to have an absolutely stonking phobia of hypodermic needles. I *did* assault people. And run out of hospitals and try to climb fences… well into my teens I’m ashamed to say. (tldr: I’m completely fine now, just a bit of operatic swearing.)

      When I was starting on my exposure therapy journey, I absolutely felt it was information that healthcare practitioners needed for *their* safety beyond just disclosing that I had a severe phobia. But it wasn’t a flat out “I will hit you”, it was “I need to sit between you and the door, because my phobia means if you’re between me and the door I may hit you to escape.” Of course, this approach relies on OP’s patient taking responsibility for the potential harm their phobia can cause others. I hope they’re trying, albeit clumsily.

      Of course, OP is fully within their rights to not worry about being assaulted at work! I think it’d be reasonable to ask if there’s anything their patient needs to minimise the risk, because it’s no joke. Of course, if the patient responds with “just don’t hurt me”, well, they need to see a different HCP first, like a licensed therapist who specialises in phobias.

      OP, you sound like an amazing and empathetic dental hygienist. I wish you the best of luck with this patient.

    11. Cheesesteak in Paradise*

      No, LW may never need that information because LW can fire this person as a patient. The responsibility to get their reactions under control lies with the patient in this case, not the dental provider who has been threatened. Or they forgo needed dental care.

    12. RabbitRabbit*

      It could absolutely be a threat, though. I’ve worked in healthcare (both with patients and not) for a couple decades and healthcare workers suffer extremely high rates of physical, verbal, and sexual assaults, nearly always from patients or the visitors that come with them.

      I will absolutely confirm that some patients would have said that out of a threat, while some would have been ineffectively communicating that they may flail/strike back out of a fear-type response.

      Now that LW #1 has had time to think about this, it’s probably time to work out responses to these sorts of situations with the dental practice manager. Do they want LW to leave the room and get a witness? Are there questions for new patients about fear/previous dentist trauma? That kind of thing.

      I’ve managed to dodge most bad interactions, but colleagues at an office I used to do research work in had at least one male patient where the (women) techs had to go into the exam room in pairs, because otherwise his hands would accidentally brush over them in semi-plausibly deniable ways during the workup. They weren’t happy that the doctors wouldn’t discharge the patient from their practice, but did find some level of satisfaction at the patient’s obvious annoyance.

      1. Typing All The Time*

        Yes. My GYNO’s office had a male physician who would bring in a female nurse to witness physical exams. I didn’t feel unsafe around him but having another woman present probably made more more comfortable subconciously.

        1. Crencestre*

          That was very likely a policy meant to protect the male doctor from a rape charge, not to protect the patient from an actual assault. Check out New York Magazine’s September 2023 article “Protecting a Predator”; the male MD who assaulted numerous women had a nurse in the exam room, but she turned her face to the wall and deliberately did NOT actually see what he was doing with his patients.

        2. Rara Avis*

          I’ve never had an exam from a male provider without a witness present. It’s to protect both — provider and patient.

    13. Also-ADHD*

      I think tone/vibe is lost here, so I do think LW may have “more information” than we can in a way. If it was a reflex thing, is there a way to address it (physically, I mean?). But if it’s a reflex thing, it’s still not okay to hit a dental hygienist (and they really should say “I’m worried I’ll flail my arm and hit you on a reflex if hurts suddenly” but I understand under anxiety people can’t convey information well sometimes).

      I don’t think we get to determine if LW was threatened or not. Healthcare workers are often abused and told not to consider their own well being and safety, and that’s a huge issue. I definitely don’t think it can be about “building trust” etc. If it’s a reflex they’re worried about, I get it, there are sometimes ways to address that (immobilizing etc) in heal situations, though no idea about dental cleaning, but you that isn’t about building trust.

      1. iliketoknit*

        I agree that not having tone/vibe makes this letter more difficult. However, the OP is concerned enough about it that the tone/vibe probably leaned “threat” more than “I’m concerned I might have this physical reaction,” or the OP might have described the situation differently.

        That said, I’m baffled by the scenario where a competent adult chooses to go to the dentist and thinks it’s appropriate to say that. I get this is probably my naivete from not having worked in health care, or not having the kind of medical trauma that might lead to such a reaction, but I keep reading this patient as a child or cognitively impaired. Not that the solution is necessarily any different, of course. But yeah, if this is a competent adult, the hygienist definitely shouldn’t have to risk getting hit.

        1. AlsoADHD*

          Exactly what I meant–if LW took it as a threat, it probably was more on that side than the accidental (i.e. I might have a reflex) sort of implication! Sorry if I was unclear on that, just responding to the idea it might not be a threat. I get that based on the diffused way LW wrote it, but LW experienced it in full.

      2. kalli*

        LW felt threatened, that’s not in question.

        Without the tone, though, some people are seeing a potential different context and in the apparent absence of a practice policy on what to do in a situation where the provider is at risk, the question being variably answered is how to address that context.

        In this particular case the LW is stuck on the ethical/theoretical, for example, how they have to explain how hitting people isn’t okay like that’s not just a given, and less so on the actual response. The suggestion for a script that includes rescheduling with someone else just keeps the patient going down a list until they get someone who is less risk-averse, or quit attending appointments; it isn’t a solution.

        All of this goes away if the practice has a policy on the matter, and someone forgot to let LW know about it.

        1. LW1*

          I really appreciated this reply. It’s true- I don’t know, and really it doesn’t matter if the patient meant it in one way or another. As the provider, I felt stuck, not having a ready script to say “you cannot threaten to hit people”. I have really appreciated several of the responses that have given me words to use should this situation ever arise again.

    14. Soft bigotry of low expectations*

      This is a bad response. Accommodating threats and putting oneself because of a patient’s trauma history is not part of this job. You can feel free to work on this person’s teeth if you like, though!

    15. Hastily Blessed Fritos*

      It doesn’t matter to LW if they get hit out of anger or a panic response. They still don’t have to tolerate that chance. The response may be different (the patient being told not to return to the practice vs. talking about ways to manage the anxiety, including medical ones) but neither one means it’s OK to say that.

    16. Hyaline*

      Though I agree that the patient was most likely stating a fact about a reflex, I don’t think that the hygienist needs to do anything else in the situation beyond what they did except adding a boundary about ending the appointment. Ending the appointment should always be an option—either enforced by the hygienist because of the patient’s reactions or by the patient because they are not comfortable continuing. Expecting her to invest above and beyond emotional labor in building a relationship with the patient is not necessarily part of her usual job and may not be effective here anyway. There are other options for the patient to do the work of overcoming or accommodating the anxiety. There are dentists whose focus is with patients who have anxiety, phobia or trauma. Maybe the LW should discuss with her boss the options exist in their area for patients like this so that she can feel confident ending the appointment that she cannot perform, and either making a recommendation or asking the dentist to step in to do so.

    17. Falling Diphthong*

      I have a really rough time with dentist appointments, and I cannot fathom “If you do something that hurts me at this point, I will hit you” as anything other than a reason to stop the appointment. If that’s what the patient means–“My anxiety has spiked so high that I’m now going to reflexively start hitting, so we need to stop”–then the patient needs to work on their phrasing.

      1. GrumpyPenguin*

        That’s the key info the OP needs. There is a big difference between “I will hit you because I’m angry the treatment hurts” and “I might hit you due to a physical reaction I can’t control due to stress”.

          1. GrumpyPenguin*

            You can work it out. Get a specialized dentist who offers sedation, talk it through and find accomodations.

          2. Observer*

            And yet, the other person gets hit all the same.

            The attitude behind the difference in how the information is delivered gives everyone a chance to find a solution, though. And, yes, it could mean that the LW is not the right person, because the client needs someone who specializes in care of people with that kind of issue. But there is a very large difference between “Hey, I have this problem, what can we do?” (especially when said in advance) and “Hey, be careful or else!” (Which is what the LW’s description sounds like.)

        1. wordswords*

          There is, but it’s extremely reasonable for OP to be unwilling to accept the chance of being hit for either reason, and important that she be able to draw that boundary (both in the sense of “my workplace will back me up” and in the sense of “I have a script to deploy if I’m in a situation where that’s been put on the table,” which is what this letter is about).

        2. Falling Diphthong*

          The difference is in the first, the correct response is “You are banned from this dental practice” and the second “We should stop in that case.”

        3. Hell in a Handbasket*

          I don’t see why this difference matters. Alison’s script works perfectly well for either scenario.

    18. Poolgirl*

      It’s quite simple. This person needs to go to a practice that offers sedation dentistry. That’s unfortunate that they have such trauma, But where my sympathy ends is where they make it someone else’s problem.

    19. Czhorat*

      It is never OK to tell someone that you would hit them unless you *do* need to make an explicit threat to protect the safety of yourself or others.

      “If you again attempt to touch my scalp/my kid’s hair/my body I will hit you” – yes.
      I will hit you in any other context – no.

      It is highly in appropriate to jump to even non-serious threats of violence, and employees have a right to NOT be told they’re going to be hit.

    20. SheLooksFamiliar*

      It’s information that carries a threat – a distinction without a difference in this case. Or you could call it a statement of intent: the patient said ‘If you do this, I will do that.’ But it doesn’t matter, the patient threatened to hit the OP and that is not okay.

      See, traumatic experiences don’t give the patient permission to nurse and/or display their fear with threatening behavior. I mean, I don’t know anyone who says, ‘Yay, I need a root canal!’, and I had a horrible experience in the dentist’s chair myself. But lack of trust – or more to the point, fear – doesn’t entitle the patient to threaten their dental practitioners.

    21. Cat Lady in the Mountains*

      I think there are absolutely ways for a patient to communicate concerns about a reflexive response that don’t at all sound like a threat though. I once had to get a series of very painful shots in a sensitive area on one of my legs. I prefaced the interaction with something like “My reflexes sometimes make me kick when I’m touched in this spot, is there anything we can do to prevent that?” They ended up bringing in a second person to hold me down, and they were super understanding about the whole thing. (The second person was very much needed; I definitely would have accidentally kicked the provider.)

      “I’ll hit you” does not sound like collaborative problem solving around a safety concern, and while it could be graciously interpreted that way, on the LW’s end I don’t blame them at all for not wanting to take the risk that that’s what they meant.

    22. Loredena*

      I’m if the patient said I MIGHT hit you I would assume concern about reflexive flailing that could potentially strike the hygienist by accident. I’ve been known to drum my feet at the dentist, so there’s a small risk if someone was leaning over my feet, I suppose. It’s the I WILL that reads as a threat.

      I think the approach at the point is to end the appointment with the suggestion of a follow up for just the next stage. Potentially taking an anti anxiety beforehand if that’s an option. I say schedule a follow up because I suspect the patient just hit their stress tolerance

      1. Loredena*

        To be clear, I don’t think it matters if they were warning about reflex or intent. If they are at the point of either it’s best to stop and either reschedule the rest for when calmer/took something or to switch to sedation dentistry

    23. GrumpyPenguin*

      But this kind of information requires context. I understand the OP is worried. I agree telling the patient that it not okay to hit him, but I would also have asked further questions. Is that how the patient reacts to stress/ fear? What can be done to prevent that? Can the patient give a warning sign when the stress level gets to high and he needs some moments to cool down? That’s what my current dentist asked me (took me ten years to find one who would see me). I had told him I might involuntarily hit him due to my epilepsie (stress can cause me to have seizures). I did actually kick him on my first appointment, but he still kept me on. Luckily the only time that happened.

      1. Managing While Female*

        The thing is, it sounds like OP had been very calm and collaborative with this patient the entire time and trying to make them feel comfortable. I think we can trust OP that when the patient said “I will hit you” and OP felt threatened, they were reading the situation correctly. OP doesn’t need to stay in a situation where someone has told them that they may be violent, whether that violence is voluntary or involuntary.

        1. GrumpyPenguin*

          Yes, just “I will hit you” is a threat. If the patient was worried about having a physical reaction, he should have said so.

    24. Someone Else's Boss*

      I understand the patient wasn’t threatening them in a mafia-like scenario, but “I will hit you” is a threat. Regardless of someone’s trauma, it is not okay for them to hit someone else. It is OK that they’re still dealing with trauma, but if hitting someone is a real possibility, they are not ready to put themselves in that situation. Period.

    25. Rex Libris*

      I actually read this through three times, just to verify that yes, it’s actually arguing that “And I will hit you” is somehow not a threat. Past trauma is not a pass for inflicting trauma on others. Full stop.

      1. Lightbourne Elite*

        THANK YOU. Others have already addressed the “soft bigotry of low expectations” part of this, which is a major concern. Mentally ill person here and yes, we can control ourselves, and implying otherwise is insulting. And mental illness is an EXPLANATION not an EXCUSE. You don’t just get to do whatever without consequences because you’ve experienced trauma.

    26. Olive*

      “You haven’t built trust enough yet for the patient to tell you the specifics of their past trauma.”

      OH NO. The LW is a hygienist, not the patient’s therapist or psychiatrist. While it would be appropriate for a patient to tell her they may have an involuntary trauma response, with the aim of them figuring out a dental-specific solution, it is absolutely not her job to hear the specifics of this person’s past trauma.

    27. Tippy*

      I’m a biter. Seriously, if I not knocked out it may happen. I’ve had dentist’s in the past tell me to always let the doctor know that.

      1. JSPA*

        “I’ve been told to inform dentists that I’m a biter, so you may need to block my jaw open with wadding, or we can discuss going to full sedation, or let’s discuss any other options you may need to work on me safely.”

    28. Observer*

      It’s information, about how the nervous system of a person with past dental trauma will respond if that trauma is repeated, and about how essential it is that you not inflict pain or retraumatize them, for both your safety.

      No. Not in the least bit. And actually *blaming* the LW for not doing “enough” is just the cherry on the whole cake of inappropriateness.

      The way to tell someone that you have a startle reflex that’s this hyper- reactive is by saying that, not telling someone that you are going to hit them. There is a WORLD of a difference between “I will hit you” and “I have an extra strong reflexive reaction to pain that I can’t always control and I’d probably wind up reflexively trying to hit you if you hurt me.”

      And, btw, if that’s what was going on it’s legitimate for the LW to not serve this client. That’s someone who needs specially trained staff or a different set up.

    29. MistOrMister*

      I read it as a threat because the first time the patient was nervouse they said if OP hurt them they would scream. But the second time they said they will scream then added on that they would hit OP. Maybe the 2nd part was more traumatic to them and they knew it would make them flail about if they were hurt, but there are ways to convey that other than “I will hit you”. The word choice makes it sound like a threat and something they would do intentionally. It sounds like OP did everything right explaining what was going on. To say OP clearly didn’t give enough of an explanation for the 2nd part of the treatment is an assumption that there doesn’t seem to be any basis for. If someone is likely to have a violent response it is 100% on THEM to share that information including why to their medical team. While the healthcare professionals should absolutely do what they can to foster trust with the patient it is absurd to tell someone who is seeing a new patient and going out of their way to soothe that person and walk them through everything that they didn’t do enough b/c the patient might have trauma they don’t want to discuss.

    30. Dr. No Abuse Allowed*

      1000% It is a threat. It doesn’t matter what’s behind it. Its totally unacceptable.

    31. Dido*

      “It’s essential for battered women not to provoke or aggravate their abusers for both of their safety”

    32. JSPA*

      But it’s on the patient to work with the provider to prevent a possible involuntary assault!

      I tell people who draw my blood (or when I give blood),

      “I know you prefer that people not tuck their feet behind the chair legs during the draw / not cross their legs and tense their whole body during the donation. But tucking / tensing while you get the needle in and fiddle with it is how I protect you and me from kicking at you. I promise you are safe if I can do that, and I’ll settle into a more normal posture as soon as that startle response is over.”

      Phlebotomists have been extremely kind and accommodating when the script is, “my body can do problematic things, so here’s the path to doing this safely.”

      “My body can do problematic things, so whelp, sucks to be you” just isn’t OK, if you’re a rational adult who is able to communicate. There are practices who have the equipment to constrain and safely work on people for whom that isn’t the case, but you don’t get to presume that any and every dentist is able to deal with those needs!

    33. Workerbee*

      “They became very nervous again and repeated, ‘If you hurt me I will scream,’ only this time adding, ‘And I will hit you.'”

      If you are a person who knows your response is so likely to be physical that you use the language “I will,” that is absolutely a threat for the person you’re talking to. You don’t say “I will” if you haven’t done it before.

    34. Mango Freak*

      Yes, they gave LW the information that they needed to end the appointment.

      At 99% of workplaces, when someone threatens to hit you, the interaction should end immediately. No one is saying that LW needed a rundown of the patient’s traumas. They needed the patient to determine whether they’d be able to get through this appointment without making threats.

      There are actually dental offices that specialize in phobic patients, offices that will sedate you for a cleaning. Made such a difference for a friend of mine. (Not that she ever threatened to hit a hygienist.)

    35. Beth*

      It might not be intended as a threat in spirit, but in practice the patient’s motives don’t matter. It could be a well-intentioned heads-up that they flail when panicking and feel like they might panic. It would still be necessary to treat that as a threat to the staff member’s safety and end the appointment.

    36. Tea*

      This is Ask A Manager, not Ask A Victim Blamer though. If the patient needs that much hand holding then they need a dental practices that specializes in traumatic dentistry or they need general anesthesia when getting a basic cleaning or filling or IDEK what. What they DON’T need is to just expect the hygienist to put up with violence or threats.

    37. ampersand*

      But they escalated from “I will scream” to “I will hit you,” even after LW demonstrated that they were being gentle and were understanding of the patient’s anxiety. Trauma response or no, it wasn’t okay, and LW’s concern seems completely appropriate.

    38. LCH*

      i also interpreted it as information, not a threat. the person knew they had an uncontrolled involuntary response. just like i don’t get pedicures. i cannot handle someone touching my feet like that; i will kick. but the dentist is harder to avoid.

      1. LW1*

        Imagine you call the salon, make an appointment, and go in to get a pedicure. You tell the provider that you really struggle with someone touching your feet. The provider talks to you about ways to make the visit work, offers a special product they have that makes it more comfortable, and you agree to give it a try. Throughout the visit the provider repeatedly checks in and makes sure you are ok and asks you for permission before each step. You make it through 3/4 of the appointment, they are done prepping your feet and you even tell the provider how well they’ve done and that it has been easier than you expected. It’s time to apply the polish and they tell you what to expect for this last part. At this point you tell your provider that if they do something you don’t like, that you will hit them. That doesn’t make sense, and the person providing your services do not deserve to be threatened. This is what it seemed like from my perspective. Of course the patient probably had a lot of other thoughts throughout the procedure, but I have only reported what they told me.

      2. Productivity Pigeon*

        But you weren’t there. You can’t interpret anything.
        The LW says it felt like a threat, and we need to believe them.

    39. e271828*

      If this person’s trauma is so profound that they will become physically violent while their teeth are being polished, they need to manage their trauma better rather than leaving “hit the dental technician” on the table as an option. They can load up on anti-anxiety meds, tell the technician to skip the polishing as they’ve maxed out on anxiety for this session, or whatever else their therapist has them do instead of hitting other people.

      I hope that LW brought this to the practice owner. They would be justified in discontinuing that patient, IMO. The patient threatened physical harm.

    40. Orv*

      It’s tricky because dental care is the only branch of medicine where pain is just accepted as routine.

  3. Jessica*

    The whole “reschedule with another provider” thing isn’t sitting well with me, because it sounds not like “you’ll have to seek dentistry elsewhere” but like “oh, let me refer you to my colleague down the hall because it’s somehow okay to slap her around.” It shouldn’t be okay to hit any provider! This whole question seems like one that should be addressed at the practice level, not just by the LW.

    1. Ask a Manager* Post author

      I took that as “if you don’t feel comfortable with me treating you, you can reschedule with someone else and see if you feel safer with them.” Not “you can’t hit me, but try Jane, she won’t care.”

      1. JM60*

        Or maybe Jane has some tools and special training she can use to ensure that you won’t hit her (even if there is some pain). I imagine that some dentists, if they know a patient is like the one OP had, could use anesthetics to prevent any violent actions.

        1. JM60*

          When I say anesthetics, I don’t just mean pain killers/blockers; I’m also thinking of sedatives.

          1. Grey Coder*

            Yes. A friend’s child has significant developmental and communication disabilities, and they go to a specialist dentist. I am pretty sure some treatments have been under general anaesthetic.

            1. Cheesesteak in Paradise*

              That’s totally a possibility but the patient would probably have to pay for that out of pocket.

              1. GythaOgden*

                It’s probably cheaper than the costs that would come from causing someone else broken bones and the ensuing legal action, though.

              2. Broadway Duchess*

                Then the patient will just have to do that. Additional expenses for needs beyond what the general public might require is not a punishment to the patient.

              3. Annony*

                It depends. Sometimes patients can get it covered if they can provide enough documentation to insurance that it is medically necessary. They make it difficult though.

            2. Hastily Blessed Fritos*

              Even “twilight sedation” like they use for colonoscopies might be an option, with fewer risks than general anesthesia. (You don’t feel pain, and you’re super mellow and don’t care about what’s going on. When I’ve had it I remember what’s going on, but that apparently varies person to person, and lots of people “wake up” afterwards despite being conscious through the procedure – they just don’t form memories.)

              1. RussianInTexas*

                My colonoscopy had full general anesthesia. They woke me up 29 minutes later and I was fully up and running, with zero lingering effects.
                Not at all like the general anesthesia 10 years ago when I had my wisdom teeth removed. I don’t remember that entire day.

      2. AnxiousPatient*

        I won’t speculate on this scenario, but there are very good reasons for both a patient and a provider to say “this is not a good fit for me, and we shouldn’t continue this provider-patient relationship” that wouldn’t apply to another provider-patient relationship.

        From personal experience, when I go to the dentist, I have a serious conversation with every hygienist and dentist that is treating me, because I have a terrible reaction to epinephrine, which is in the numbing agents (lidocaine) used in most dental practices. There are options without epinephrine, but they don’t last as long, so they aren’t preferred, and I’ve had dentists revert back to the options with epinephrine. Depending on my state of mind, this can cause everything from panic attacks to fainting spells to manic energy.

        To that point, I have to have a dentist that I feel safe with, one that is willing to promise to never use those particular drugs with me. But I discuss this before anything starts, and if I don’t feel like they are onboard, I will walk away.

      3. Smaug*

        Agreed. And also with that, just a polite but clear way of letting them know that the visit will be over. We’re not gonna refuse to treat you at all in the future, and we can try to make an arrangement that will work for you if you are that uncomfortable with me in this moment, but you will be leaving this visit.

      4. LW1*

        Hello all! LW1 here! In our case it would referring them to another office who can provide sedation dentistry. I’m the only RDH on staff at my office- so I was definitely thinking of a thoughtful referral to a practice who might be able to provide sedation dentistry or whatnot.

        1. kalli*

          The script should include that, like ‘we can refer you to a practice that specialises in working with people who have reflex reactions to pain or deal with dental trauma’.

          Otherwise any ‘it’s not okay’ you include is watered down and can be easily interpreted to mean it’s just you it’s not okay with.

          Even though you’re the only RDH on staff there should be a practice policy on dealing with difficult patients you can refer to, though, which should include when to refer and when to pull in a second staff person etc.

    2. Ellis Bell*

      I find that such an unusual read; the whole point of stopping the appointment is to make clear that hitting is unacceptable; there’s no suggestion that the patient should continue hitting, quite the opposite. Just because the appointment had to be stopped on the first try, doesn’t mean the patient can’t try again, or try a different provider.

      1. Kuddel Daddeldu*

        There might be providers better equipped to handle the patient, e.g. with sedation or restraints (if a patient knows they may involuntarily jerk their arm, for example, tieing down the arm to the armrest with a bandage might make it safe for both provider and patient). Not all dentists have the knowledge or equipment to treat patients under sedation as this requires additional monitoring and potential intervention, but many do.

    3. Awkwardness*

      Another provider might have even stronger boundaries and stop the treatment the moment somebody is threatening them.
      So the patient has to really think through how much they want to go on with OP whom they already got to know.
      That’s why I liked the answer a lot. It redirected responsibility to constrain themself back to the patient who would have to go through everything again instead of placing the responsibility for “gentle treatment” only on the provider.

    4. Hyaline*

      In this case, a referral to a provider specializing in dental phobias would be an appropriate response rather than a vague “reschedule with another provider” (and definitely not with “my colleague down the hall”!).

    5. TPS Reporter*

      yeah it is a confusing thing to say IMO. It can be taken many ways.

      What if the OP said- “we need to stop the appointment. I will discuss with management the best path of treatment for you before we do any further work.”

  4. Pink Sprite*

    For OP 3 – When you met with the two people that you already did, were you just coming in with concerns/complaints?
    Or discussing those topics AND possible/reasonable/feasible solutions?
    Alison has talked about this many times before about being prepared to talk about the flip side of only complaints.

    1. Trout 'Waver*

      I think OP#3 came to their boss correctly, because they report feeling listened to.

      But I’m confused by everything after that. Because escalating the issue to their boss and feeling heard is the off-ramp. Everything after that feels like they’re undermining their boss. If I had an employee on my team do that, there would be some shortly thereafter be some coaching about expectations regarding chain of command and escalating issues.

      1. what was my username??*

        my impression is they need to let those two tiers of leadership they already spoke to escalate it. I wonder how OP would feel if one of their subordinates jumped over them and went to talk to their boss.

        Chain of command exists for a reason.

      2. ferrina*

        Seconding Trout ‘Waver.

        I’m confused why LW is escalating the issue to top leadership if they’ve already talked to their Boss and Grandboss and feel supported. Where are Boss and Grandboss in this? Are they aware that LW is doing this? Everywhere that I’ve worked, issues get escalated through chain of command. Sometimes the command will bring in others in their reporting structure for more information, but in that case, it’s the leaders that set the meeting and invite others.

        Speaking as the manager that has had to escalate these conversations, it can take time! I worked one place where it took months- the leadership was aware of the issues and didn’t care, and I had to carefully win political favor so I could set up a pilot program to address the issues. The leadership was petty and retaliatory and hated when people gave them recommendation or gave suggestions (yes, leadership was a problem, but unfortunately they weren’t going anywhere). Several experts (including me) had tried the direct route of “hey, this is a problem” and gotten shut down, and it was clear that the only way we would get the issue solved was to play politics. I gained favor and got their blessing to set up an unresourced pilot program (major step forward!). The program was gently getting traction, when one of my direct reports decided to take matters into her own hands. She directly complained about the lack of resourcing to leadership (skipping several layers). They got mad that she was telling them what to do and we lost all support for the program and were told to shut it down. I had even told her multiple times that directly complaining wouldn’t get the results she wanted, multiple (highly respected) people had tried that, and we needed to do things the political way. She ignored me and torpedoed the whole program.

      3. Glazed Donut*

        Right. In most places, you don’t have an open door to the top-level CEO merely because you have an issue/complaint/solution. I could see this in some really small orgs, but since LW already has 2 layers between their position and the top, this doesn’t seem that small.
        Taking it to one AND two levels above IS attempting to fix it. After that, it’s out of your hands.

      4. AlsoADHD*

        It can depend a little what kind of role, and org, you’re in. If, for example, LW is in some kind of operational change management (which would make sense with the concerns, but I don’t understand in what context these concerns are being brought), is the head of a whole division/function, etc. LW definitely doesn’t do what I do as far as I can tell, but sometimes, I do have to go up 4 levels to discuss with C-Suite and be heard directly, the layers above me don’t do what I do/wouldn’t report up or own the kinds of projects I’d need to directly address. I work in a weird niche right now, though, so I understand if you worked in more a straightforward function, that doesn’t make sense.

        Some roles are more oddly matrixed, where you may report one way but work across the business, and then there are reasons you need buy-in from the very top. And you also need to know if your direct manager and the C-suite are in alignment and sometimes help them build consensus when they aren’t and no one’s talking about it. I would be concerned if I couldn’t get buy-in directly from C-suite for certain things and it would change the way I approach projects. My boss is always informed, but they don’t exactly direct my work. And there’s just one of me–in my last org, where I used to be a team lead, there were all these hierarchical levels and clearer reporting, but sometimes you’re doing work that is very specialized in addressing problem/solution across the org.

    2. JelloStapler*

      I’m also wondering if OP is expecting immediate results and thinks they must go straight to the top because they are not seeing them implemented yet.

      These things may be addressed, but they may take time….. or they don’t get addressed, and you decide if you stay on the job.

    3. Retired Vulcan Raises 1 Grey Eyebrow*

      I’m puzzled why OP3 wants to talk to the top leadership when she’s met with the 2 levels above her and says they “heard” her.

      If it’s because only top management has the power to make the changes she wants, it’s better to let her managers push for this rather than trying to skip over them.
      If she thinks her boss and grandboss don’t support what she wants, it’s very unlikely that she can persuade the top bosses to overrule them.

  5. NeutralJanet*

    LW5 – I’m not sure I understand how the employees in question are having management “stick it to them.” If I understand correctly, the vacation is paid and it’s only for people who already have a lot of vacation days accrued, right? Is it just that maybe you wanted to work every day in June and take a longer vacation later, and now you don’t have that option, or are you somehow losing a vacation day without having a day off?

    1. Captain dddd-cccc-ddWdd*

      People are holding on to the accrued pto, either to take it later or intending for it to ultimately be paid out if/when they leave.

      I’d be more concerned about the bigger picture than about being forced to take a couple of vacation days. The company announced poor results and is in a slump. Now they are getting financial liabilities off their books. What does that say about the stability of the company? I might be inclined to use some of those enforced days off for job searching.

      1. darsynia*

        Accrued PTO has to be paid out at the salary the worker makes at the time they take PTO or leave the company, too, right? So a large bank of PTO technically costs more now than it did when the first hours were banked? I wonder if there’s a confluence of ‘summer is less busy’ and ‘raises tend to happen in the fall’ and they’re trying to, as you’re saying, sort out the financial liability there– but maybe not that there’s anything wrong.

        1. Captain dddd-cccc-ddWdd*

          OP says that the company linked the poor performance and this request in a cause and effect manner, though. “Results weren’t good, so we need to start cutting relatively small financial liabilities” doesn’t seem to bode well. have they already cut other things that could make more substantial savings and this is what’s left?

          1. Eldritch Office Worker*

            Or fixed expenses are more tenable for the company than large liabilities and this is on the list of logical places to make some cuts.

            These aren’t necessarily small liabilities on the balance sheet depending on the number of employees and how much PTO people are hoarding on average. This doesn’t seem like something to overreact to.

            1. Handlebar*

              I wonder if the company is looking to sell, and potential buyers don’t want to see these debts on the balance sheet.

              1. Eldritch Office Worker*

                I mean an internal auditor or CFO wouldn’t want to see them either. They’re not arbitrary numbers, liabilities are just that – financial liability.

          2. Annony*

            It’s hard to say. I worked somewhere that did something similar except instead of forcing people to take the time off, they paid out all accrued vacation over X hours. We were in an essential field during COVID and people were not taking time off since it was an all hands on deck situation. They were financially stable but the shear number of accrued hours was too much of a liability.

          3. Hannah Lee*

            Though … they’ve got the cash to be making the payments, through payroll if the employee works instead of taking these required days off, or through PTO if they take time off. And are not downsizing, laying off employees.

            So while I think it’s worth it for employees to keep their eyes open about the situation, and for other options just in case, this doesn’t fully read as doom and gloom to me.

            Accrued PTO/Vacation liabilities, beyond the amount that’s needed for current employees to be able to take time off in the coming year (like whatever they’d normally accrue in a year), maintaining employee satisfaction, work/life balance, a good environment for the company to continue doing what it does well, don’t really do anything to improve the business. Paying that out, down to a “useful for the employer” amount isn’t necessarily a bad thing. It’s just cleaning up the balance sheet for that company’s operations OR if they are going to be seeking additional funding, or possibly selling (neither of which are necessarily bad things for the company or employees … they could be, but could also make things better for employees, in some ways)
            Also, some employees will tend to ‘hoard’ time off (for a range of reasons) which means they aren’t taking time away from work (which can lead to burn out), and can accumulate balances that if they DID suddenly decide they wanted to schedule a chunk of it, can through off workloads/staffing more then them just schedule the normal amount through the course of the year. Having people who have several years’ worth of PTO accrued start to use it and bring their balance down isn’t an unreasonable or punitive thing.

          4. JustaTech*

            During 2020 my company asked people to take their PTO explicity to get it off the books and improve our financial outlook – even though obviously no one was going anywhere.
            So I dutifully took every Friday off for the whole summer (and went up to my home office and sewed masked for my coworkers). It didn’t help save any of my coworkers when layoffs came, so I was irritated.

        2. Lisa*

          “Accrued PTO has to be paid out at the salary the worker makes at the time they take PTO or leave the company, too, right?”

          Not necessarily. In some US states this is a legal requirement. In the state I live in, it is not. The law just says that companies have to follow any written policy or contract they have.

          1. fhqwhgads*

            My understanding is:
            some states have laws requiring accrued PTO to be paid out on separation
            any state not having a law specifically requiring accrued PTO to be paid out on separation is still held to if they have a written policy they have they must follow it

            However I’m not aware of any state with a law specifying that you can pay out PTO at the pay rate of the employee at the time it was accrued rather than the pay rate at the time of separation. And I don’t think it would be legal for a company to have that policy. Financially, the liability is because if the person used the time, they’d be paid at their current rate. So when you pay it out, that’s got to be the same. Otherwise that’s sketchy bookkeeping.

            So whether to pay it out or not is either state law or company policy. What the rate of pay is has to be the employee’s rate of pay at the time, regardless.

            1. Kevin Sours*

              I would be a bookkeeping and morale nightmare but I don’t think it would be illegal explicitly have such a policy in states that don’t guarantee PTO.

      2. ferrina*

        Alternate plan: Management switches to unlimited PTO. That way no accrued PTO is on the books.

        Depending which state they are in, management may or may not even need to pay out the accrued vacation.

        1. Data Bear*

          THAT is what “sticking it to them” would be, if you ask me.

          We accrue a lot of PTO where I work, and I have a lot banked — way more than I’d be able to use if we switched to “unlimited.”

          It might be a good plan from management’s POV, but it would be a real detriment to a lot of others.

          1. Bitte Meddler*

            I have only ever worked at one company (out of maybe a dozen over my lifetime) that let me accrue PTO year after year. All the others had a use-it-or-lose-it system.

            What OP’s company could do is pay out the currently-accrued PTO that is more than what someone can accrue in a single year, then switch to use-it-or-lose-it (or unlimited).

      3. LCH*

        my workplace did this during 2020/2021. but they required us to use much more of our time (10 days!!) by a certain date. i had already planned to use mine for something specific past that date so had to negotiate and assure them i was going to use up the time. it was definitely to get rid of the financial liability, but it really pissed off a lot of people.

      1. Testing*

        You can just stick yourself like that :-) These people have the accrued time, they just have to take a little bit of it off.

        I hope and assume the management in this case will then approve the chosen dates and not try to move them.

        1. Pastor Petty Labelle*

          One day if you have 100 – 150 hours. that’s over two business weeks of vacation, and you lose one. Over 200 hours is 25 days of vacation, so you wind up with 22 instead. This is not sticking it to people in a way that seriously hurts them.

          1. Lurker*

            But they’re not even losing the time, they are just being forced to take a day off. Losing it would be having their PTO reduced and not getting paid out for it* or not having that time to take off as paid. Not really understanding LW#5’s outrage.

            *Getting paid out for accrued but unused vacation isn’t a law, it’s company policy. Obviously if they’re carrying this as a liability on their balance sheet the company does pay out. (Otherwise they wouldn’t need to record the value.)

            1. I'm just here for the cats!*

              The company may be required by law to pay out PTO at end of employment. There are 20 states that require this.

              1. Also-ADHD*

                Many of the states that “require” it don’t necessarily. For example, NY “requires” it but if you have a written policy and structure PTO a particular way, you can get around it (even with accrued time), and that’s not uncommon. Many states let you just create a policy that says PTO isn’t paid out at separation and then you don’t have to. Even most of the ones that actually require it be paid out don’t require any rollover from year to year (a few do).

            2. ferrina*

              Exactly. I’m not understanding the outrage either. This is pretty normal practice? And if the company isn’t doing well financially, this is a low-impact way to cut the budget.

              Would LW prefer layoffs? It sounds extreme, but I know executives that have had to make that decision.

          2. Tio*

            Right? This is a massive amount of time they’ve let people accrue. Most companies I’ve been at cap PTO accruals way before then, if they even roll over year to year. I’ve seen employees been asked to use their time off way before this kind of cap.

            That said, I wouldn’t be surprised if after this they implemented some kind of cap.

            1. Miette*

              Most places I’ve worked in the past have a cap in place, so I’m not sure why OP thinks this is an issue. Consider yourself lucky to “have to” take this time off–I’m a contractor, if I don’t work I don’t get paid.

          3. PotatoRock*

            Yeah, the thing they’re upset about isn’t “losing” the day as in not getting a day off, but “losing the ability to plan to take XYZ day off later”. For some people it might not be a big deal – a day off now vs. a day off later – but for some people it will legitimately throw a wrench in their plans (“I have family abroad and had saved up PTO for a 3 week trip to see them, that now I have to change arrangements for”). It’s a legitimately frustrating situation for the employee, even though it’s common and makes business sense.

            1. Pastor Petty Labelle*

              I thought about this when typing my comment, but I didn’t want it to get too long.

              I think situations like that where you are saving for a longer trip, you can ask for an exception. because the point is to get the liability off the books. If the company knows it is coming off just a little later than planned, they might be willing to be flexible. The issue is the people who are saving it for a big payout when they leave.

        2. Hastily Blessed Fritos*

          I wish I could be in a situation where my vacation allocation is so generous I could have that much accrued!

          1. fidget spinner*

            Same! I get 10 days a year, combined sick and vacation pay. It doesn’t accrue at all, and it doesn’t get paid out if we don’t take it.

      2. fidget spinner*

        Right, I get 10 days combined sick and vacation pay per year, and they don’t roll over to the next year.

        I totally understand that people who were just banking PTO and planning to get it paid out when they leave are disappointed, but dang. I wish I had that problem!

    2. Msd*

      I think they are annoyed at having to take a vacation day because they like having a big bank of accrued days. If they were to leave then it’s a nice payout (in the states that require vacation payout). At one of my jobs some people never took vacations and had 3-4 months (or more) of accrued vacation. Eventually the company started restricting how much could be accrued.

      1. Banana Pyjamas*

        I could see this if they were targeting higher vacation accruals, but 100 hours is only 2.5 weeks. That’s the same as annual accrual at a lot of places. At my last job you accrued two or three weeks depending how long you were with the company. Anyone who planned to say move kids to college in fall or go on a cruise over winter break now won’t be able too because they were forced to take their vacation time in summer. Anyone who planned to take vacation pay during FMLA also won’t be able to.

        If management handled it better, they would only require time off to be scheduled, rather than forcing everyone to take time off at specified dates.

        1. MK*

          People with 2.5 hours of PTO will have to take 1 day off; they aren’t being forced to use their entire PTO in middle of the year.

          1. Wilbur*

            The way I read it is you’d have to take vacation in May, June, and July, so employees with 100 hours would be required to use 8 hours in May, 8 in June, and 8 in July.

            “mandatory vacations will be required for May, June, and July.”

            Limiting to employees with at least 3 years is good, I’m guessing that should limit impact on workers that don’t accumulate much vacation.

            1. MK*

              Employees with at least 100 hours of PTO will have to take 1 day off in May. The ones who also have to take 1 day off in June have at least 150 hours of PTO and the ones who will have to take another one in July have at least 200 hours of PTO. At the end of policy, at the very worst case an affected employee will have 90 hours of PTO with more than half the year over. The company isn’t leaving people without PTO in the middle of the year.

              1. Banana Pyjamas*

                I didn’t notice that it’s only one day each time, that’s less bothersome.

                IANAL so I don’t know if this could set precedent, but courts have ruled that employers can’t force employees to use accrued comp time. This feels similar, but that case DID differentiate between comp time and other types of time off. Employers are allowed to require employees to use comp time before using other types of pto.

                The courts found that requiring employees to use their comp time was the same as telling them how to spend their paycheck. We often refer to time off as part of the total compensation package, so it feels pretty similar.

        2. NerdyKris*

          They’re only being told to take one day, not all of it, and June is halfway through the year.

      2. MK*

        Vacation payout is not a right though. PTO is supposed to be a way to assure workers don’t burn out, not an extra monetary bonus when you leave, and the employer isn’t doing anything wrong by having employees take a day off.

        1. Spicy Tuna*

          At my last job, I always kept my PTO balance at the max so I’d have a nice bonus if I left or was let go. I got an extra 2 months pay when I resigned! But, I am someone who values money more than time and I am a bit of a hoarder

          1. Sloanicota*

            This makes sense, but a lot of jobs have policies to make sure employees don’t do this, in part because they believe taking regular vacation is good for productivity (and partly because they don’t want a big liability on the books if enough employees are doing this; they’d need to have a huge cash reserve to pay out if a few people left at once).

          2. Eldritch Office Worker*

            If you have a company that let’s you take advantage of your PTO bank that way, there’s nothing wrong with doing that. But it’s not the point of PTO as a benefit and banking it for the money isn’t a right everyone has.

          3. MK*

            That’s your choise, and if your company was ok with that, no harm done. But they wouldn’t have been “sticking it to their employees” if they didn’t allow it.

      3. Nebula*

        Yes, and I think OP’s sense that this is ‘sticking it to them’ suggests that there may be that kind of culture in play here, where people tend to hold onto a lot of holiday. At one of my previous jobs, after having a policy where you could just accrue annual leave indefinitely – and we had a leave allowance of 32 days plus public holidays, so it wasn’t stingy to begin with – they changed it so that you could carry a maximum of ten days over to the next calendar year, and you’d have to use those ten days by the end of March or lose them. Still very generous, but people were in uproar about it. One of the major complaints, I recall, was the end of March deadline, because the school holidays for Easter are usually in April. There was a concerted (ultimately failed) campaign to extend the deadline to April so people could use their carry-over leave for that.

        It was also a particularly travel-heavy organisation, and you got time off in lieu for any travelling hours and extra hours worked over a 40 day Monday to Friday week – so some people who travelled a lot basically never used any of their actual annual leave and took holidays entirely from TOIL so they had years’ worth of leave built up. There was definitely a sense that many of these people did that in order to get a payout if/when they left, and since it was the senior people that travelled the most, those payouts were pretty generous. This was definitely a factor in them changing the policy, I think, and fair enough.

        When I left that organisation five years later, there were still people who complained about having to use up all their leftover leave by March. It was ridiculous.

        1. Nebula*

          Having said that, I misread the totals in the original post, and I can see now that people with not much leave are being forced to take some time off at a time that might be inconvenient. That’s not great, I agree with others that ideally they should just ask people to schedule it in by the end of the year or something.

            1. Nebula*

              To be honest, I am not used to measuring it in hours – how much that amounts to depends on how long your working days are – and I am also not used to the American thing of having all kinds of leave in one bucket. So I think I worked it out wrong twice lol.

              1. Hastily Blessed Fritos*

                “All kinds of leave in one bucket” isn’t standard, but it’s certainly an option. I’d been assuming this was vacation only.

                200 hours is 3.5 weeks. By American standards that’s quite a lot. Being asked to use 2 days of it isn’t punitive – they’re still left with 3 full weeks plus whatever they accrue in the second half of the year.

              2. Tio*

                100 hours is 12.5 days. They would make you use one day, and you would have 11.5 days left. And possibly still be accruing. That doesn’t seem wild to me (for America, anyway) as most companies don’t even give that much, at least without capping.

          1. MK*

            At the very worst case, an employee will still have more than two weeks of PTO with less than half the year gone. That’s not egregious, and my guess would be that they already tried to have people schedule it and met resistance.

        2. djx*

          My org has a policy like yours and it sucks. I don’t want to be able to hold on indefinitely, but at least six months. Some years due to family in another country I might want to take a lot off time off and some years not so much if wasn’t visiting. With a two-week international trip, then in that year I have so little other time off. Whereas if I could store it up over a longer time frame then the “hit” to other time off is spread out.

          Oh, and one year we had a big staff event in April that HR was the lead in. So they extended the rollover period to June that year, instead of to March, since “everyone is so busy.” WTF – I’m busy all the time but when HR felt a crunch the policy got shifted. That’s BS.

        3. Joanie*

          My company has very generous vacation, and has always allowed employees to carry over as much as you are entitled to, so if you get 2 weeks, and use none of it, you can carry over 2 weeks, 5 weeks, same thing. but, you have to use your carryover in the following year. it actually works well, since once you get to a point of having 5-6 weeks, carry 2 over, you use those 2, still have that year’s vacation, and unless you take more than you did the previous year, the cycle just continues.

          1. Joanie*

            That being said, I am someone who takes my time off. I never had much to carry over, until the pandemic, and now I generally carry over 1-2 weeks.

    3. Nodramalama*

      I don’t understand it either. At my job they start hassling you to take leave if you have over 60 days of vacation time

          1. AngryOctopus*

            There may be other issues here based on how they phrased the directive, but forcing someone to take 1 day off (even if that list is per month its 2 days total?) if they have 2.5 weeks banked (5 total days if they have 200 hours, which is 5 weeks, again if it’s days per month you have to take) is hardly a hardship. If you had 5 weeks banked for some huge trip in Nov and they make you take 5 days off over the summer, aren’t you going to gain that time back anyway by Nov?

            1. djx*

              I it might not be a hardship, but it’s a benefits cut. Constraining a benefit is cutting the value of the benefit. I can accept that if the org literally feels it can’t afford it, but if they say it’s to encourage time off for re-charging that’s BS. I know my needs better than the org.

              I mean, sure, a 0.5% salary cut is hardly a hardship to some people, but it’s still a cut.

              1. Allonge*

                It’s not a cut though – you get a paid day off.

                There is a difference in how much you can choose the particular day, but that may be constrained anyway.

      1. Bumblebee*

        60 days is 480 hours, that’s an amazing amount to accrue (and I get to roll over 360 hours so I know amazing!).

    4. Ariaflame*

      I mean if they want to take a bigger chunk of leave later then would booking it now reduce their accrued leave to where it wasn’t a problem surely?

      1. Banana Pyjamas*

        Maybe. It depends on how the time keeping system is configured. At my last job the accrued leave wasn’t reduced until the pay period the leave was taken in was paid out.

      2. Hannah Lee*

        It may depend on the company’s financial and tax reporting periods, and where the taking of that big chunk of leave would fall. If one person said “I’ve already got 2 weeks vacation on the books for my honeymoon in September, can I skip taking the required day off in May or June?” TPTB might be fine with that.

        But if that block of time off wouldn’t be until the following calendar year or tax period, they might hold to the policy, and remind the employee they will continuing accruing PTO even after this summer so they’ll be able to bank more before their planned time off.

    5. Sloanicota*

      I was also thinking “wow, that’s a lot of hours! No job I’ve ever had would let someone accrue and sit on that many hours.” They either don’t let most of them roll over (so you would just loose a huge chunk of that time at the end of the year – without being able to take it as you’re being prompted to do here) – or they would have told your manager to make sure you spent them down in a quarterly way. The process described doesn’t seem particularly unfair to me.

      1. bamcheeks*

        Do you think two and a half weeks is a lot of hours? Six weeks plus is about where I’d start thinking it was a lot — two and a half weeks seems like a very normal amount of annual leave to have. (It’s what I have right now until December, and it’s only a week in August and a week for half-term in October!)

        1. Sloanicota*

          To be fair I work at small places that don’t give a ton of PTO (and they do things like “close the office in December” which doesn’t come out of employee PTO).

        2. Hlao-roo*

          Do you think two and a half weeks is a lot of hours?

          (US perspective here) I don’t think earning/receiving 2.5 weeks per year is a lot, but I do think having 2.5 weeks banked in May is a lot. At companies I’ve worked for, I accrue leave at a rate of X hours per pay period. I start at 0 hours “in the bank” on Jan 1, and accrue from there. So to me, having 100 hours in the bank in May means either the employee rolled those hours over from previous years or earns/receives about 6 weeks of leave per year and both those scenarios feel like “a lot” to me.

          Of course, that reasoning assumes that employees accrue vacation at a steady rate (some companies may put a number of hours “in the bank” at the beginning of the year instead) and assumes that the company runs on a Jan-Dec calendar year and not some other set-up. Those assumptions might not be true.

        3. Wilbur*

          “Unlimited” time off policies in the US are becoming more popular, but I think it’s pretty common in the US to have 80 hours (10 days) of vacation if you have less than 5 years at the company, 120 hrs (15 days) for 5-10 years, and 160 (20 days) hrs for 10+ years. I think rolling over vacation from year to year is becoming more uncommon due to the financial liabilities. This would be in addition to sick time, holidays, etc. There are definitely companies with more generous leave and some with less generous.

        4. RussianInTexas*

          I have 10 vacation days (so 80 hours), plus 4 sick days (32 hours) total for a year. And 5 paid holidays.
          Over 100 hours of vacation would be amazing.
          At my old job I had 25 vacation days, none rolled over, so I took every single one. 25 days is 5 weeks, and it’s a rare for a US company.

        5. MigraineMonth*

          My current job gives vacation as a lump sum in mid-December that is earned throughout the following year. (It took me a while to figure this out, so I was constantly confused by how I had so much/so little accrued.) Hopefully OP’s company doesn’t have a policy like that!

          I think the funniest policy was that there were two leave banks, vacation (expired after one year) and sabbatical (didn’t expire). So every December, everyone at the organization had to find, fill out and submit a form to payroll asking to move their vacation balance to their sabbatical bank before they lost it. Someone finally decided to automate that process and saved hundreds of employee (and especially payroll!) hours.

    6. Hyaline*

      I can see how it might be frustrating to have a policy come down in spring that might affect summer planning (maybe someone in that 100 hour bin had a two-week vacation planned in July and likes keeping a buffer of a week PTO available, idk) but it’s really not the end of the world? If people are used to hoarding their PTO for a payout when they leave, it’s not “sticking it” to anyone to make them use it as intended instead. And this is a pretty mild “use it as intended” policy!

      1. Managing While Female*

        Yeah, seriously. At my job, we would never be able to accrue that much PTO, as we only get about 3 weeks a year, and can only roll over a week. I think OP needs some perspective here.

        1. RussianInTexas*

          Right, in the US the average is just 15 days after 5 years of service. LW company has a rather generous vacation accrual.

      2. Ama*

        I also wonder if in that case you could just talk to your manager and say “look I wanted to use all those days in July if I go ahead and put it on the schedule now will that satisfy the request?”

        1. Ann O'Nemity*

          Yes, this. The company just wants to lower their financial liability on the books. They may offer some flexibility if the OP explains they have plans to use a bunch of time in the next few months.

    7. Judge Judy and Executioner*

      I was also confused by that, it’s unfortunate, but things like that happen frequently in the business world. I once worked at a place while they declared bankruptcy, everyone got their pay cut by a significant percentage. The percentage basically rolled back several years of cost of living increases, and the higher you were in the company the more your pay was cut. A place a friend worked was going through financial difficulties, and every single employee at all levels was required to take a number of unpaid vacation days in a specific month. Neither of these were seen as “sticking it to the employee”, as the cost savings measures helped keep the company going and helped avoid layoffs.

      Now, is it scary to work for a company taking these kinds of cost savings measures? Absolutely, and it did make employees question the stability of the organization. Some people starting looking for a new job as soon as their pay was cut, and no one blamed them for leaving. But overall, both companies were able to move forward and have not had to take such drastic measures since.

      1. Pastor Petty Labelle*

        this is also one day or three days depending on how much you have. Which is presumably paid because its part of the employee’s PTO bank.

        I mean the folks who have to take 3 days in July are looking great. Fourth of July lands on a thursday this year. So you take July 3 and July 5 off and you are set for two of the 3 days.

        1. Saberise*

          That isn’t what it says though. If you have 200 hours than you also are in the first two groups. So you would need to take 1 day in May, 1 day in June and 3 days in July. So you have to use 5 days.

          1. fhqwhgads*

            Right so people with 12.5 days banked need to take 1 day in May, so they’re left with 11.5 til they accrue some more. People with almost 19 days need to take 1 day in May and 1 in June. So they end up with 17 days until they accrue more. People with 5 weeks banked need to take 1 in May, 1 in June, and 3 in July, so they end up with 4 weeks by the end up July until they accrue more.
            This could suck for some depending on their plans, but in my experience it’s much more common for employers to say they’re switching to use it or lose it, or changing the accrual cap so you won’t accrue any more til you use enough to go below. So in the grand scheme of things, this one time “use some” measure is less of a loss than what usually happens.

      2. RussianInTexas*

        Back in 2020 partner’s job made everyone making over $100k/year to take 2 weeks of furlough.

      3. Turtlewings*

        “and every single employee at all levels was required to take a number of unpaid vacation days in a specific month” — I worked for a city library that started a very uncool habit of requiring a week or more of unpaid “furlough” toward the end of the year. I’d absolutely take using an unexpected vacation day during the summer over losing a week of pay in the middle of holiday expenses. I feel that LW #5 is experiencing a mild inconvenience at worst.

    8. doreen*

      People tend to think of any changes they don’t like as “sticking it to them”. It doesn’t really matter what the changes are or even if the change is not in the rules but only the enforcement. I’ve seen people become outraged because they were no longer allowed to have a TV on their desk and because they could no longer claim to have worked seven hours when they really only worked two. ( I worked at a place with a particularly bad culture when I started and changing it took at least a decade with a lot of wailing )

      1. Pescadero*

        The changes make the benefit less valuable.

        “Take a day off whenever you want” is worth more than “take a day off in June”.

        1. Firefighter (Metaphorical)*

          Yes, but all these people have enough time accrued that they can ALSO take 2-5 weeks off whenever they want to, as well as one mandatory day off in June. Another person not seeing the outrage.

    9. Momma Bear*

      It is very very common for companies to have a “use or lose” threshold, especially in times of financial insecurity. My company only allows you to carry over 80 hrs and some companies don’t allow carryover at all.

      That said, I would 1. clarify if this means “by July all employees with more than 200 hours take three days total” or if “by July everyone with more than 200 hrs takes 5 days total” (as in, if they meet each threshold, they take that amount of time that month). I’d also talk to HR/my boss if I had upcoming leave planned, such as a surgery or a long vacation, and if I could “count” those days toward this mandate.

    10. Katie*

      I like my PTO to be at a max in case anything happens. My work gives plenty of PTO. They provide paid sick leave if you are out more than a week but doesn’t if it’s not the employee that is sick. My kids have been in the hospital for weeks at times, so it’s a great buffer. I haven’t gotten it low enough to sweat it due to that.

      That being said, I wouldn’t blink at having to take a day or two each month during the summer.

    11. NotRealAnonForThis*

      I assumed it was frustration at being told how one was to use their vacation time, whether or not that is how one had planned to utilize said portion of their compensation. Because having to use part of your compensation (vacation days) when it doesn’t line up with your plans (partner and/or kids not being available to actually, you know, vacation during those times) and then not being able to use it later would indeed be irritating.

    12. starsaphire*

      This is so, so common in tech, though. A company has a bad quarter or two, and they start talking about adding on some shutdown time around one of the major holidays.

      And you have to really stop and think about it when you’re getting a job offer. Because “3 weeks of PTO per year” sure SOUNDS generous when you’re applying – but then you figure out that the Christmas shutdown and the Thanksgiving shutdown, etc., are 1 or 2 days of holiday and the rest is coming out of your PTO. And suddenly that 3 weeks turns out to be about 4 or 5 actual days.

      But yeah, this is super common.

    13. iglwif*

      This is my question also. Unused vacation has to be paid out when someone leaves or is laid off, which means it’s a liability on the balance sheet. They aren’t making people take unpaid time, right? These will be paid vacation days. I don’t see how “take a day off this month” is sticking it to anyone.

    14. Orv*

      I wonder if they have a lot accrued because their workload, or policies for approving vacation, don’t let them take it?

      1. H.C.*

        In my case, nope – just a fairly generous PTO accrual & cap policy (20 vacay days, 10 sick days & 3 “floating holidays” a year + a 480-hour vacay & 72-hour holiday caps) and my preference to hoard them in case some personal catastrophe requires extended time off and as a personal severance bonus when I leave that employer (not to mention the “value” of those days grow as I get promoted, raises & COLA too.)

  6. ChattyDelle*

    LW1-, I think a long silence is also a very effective way to let a customer they have stepped over the line. since you were able to complete the treatment without incident, hopefully the client will realize their fear can be managed and the conversation will not need to happen. but maybe out a note in their file, to remind yourself?

    1. Ellis Bell*

      Yes! I think OP is underestimating the validity of their response. Having no reaction at all, resisting the urge to minimise is a pretty strong response even if it’s not as explicit as OP would like. Silence is powerful.

      1. Awkwardness*

        That was the first thing that came to my mind when reading the letter. Some uncomfortable silence during the rest of the treatment can communicate the inappropriateness of the comment too.
        LW did fine!

      2. ferrina*

        Yes! And poor LW is being too hard on themself. Their response was good! Could it have been slightly better to say something? Sure, but LW was caught off guard and in a weird situation (seriously, what is wrong with that patient that they thought it was no big deal to hit their provider?)
        LW did great

    2. WellRed*

      Agreed. Letting that statement just hang there in silence may have been fairly effective.

    3. Lady_Blerd*

      That’s what I got from their reaction as well. It’s possible that the patient is so obtuse that they didn’t notice how their statement was met but I think the way the appointment went after what they said was a statement in itself.

      1. Eldritch Office Worker*

        I agree. And if the message didn’t get across and something similar is said next time, OP can use some of this language then. But silence is a more powerful communication tool than people realize sometimes.

  7. Nodramalama*

    For LW1 as someone who used to work in a support role at a medical centre, just because youre a health professional doesn’t mean you have to put up with all behaviour. We used to have a list of abusive and dangerous patients we were to turn away.

    I think Alison is right. Don’t treat it like they’re rude, treat it like it’s a serious comment and tell them the appointment can’t continue if that’s a possibility

    1. el l*

      Agreed. Even if there’s an understandable reason the person would hit you (the trauma mentioned above) …

      That’s crap you’re not paid to take. Boxers, yes, but not you.

  8. talos*

    LW5: at least you’re not at my old job, where one year they made *everyone* take 4 Fridays off in July+August, and two years before that they made *everyone* take a week off in August (these with…about a month of notice). And this in addition to the *mandatory PTO* 4-day holiday shutdown.

    All of these were required regardless of PTO accumulation. If you had already taken all your PTO, you would have been forced to take unpaid time off.

    1. Tisserande d'Encre*

      forced unpaid time off?!? I hope everyone immediately started job searching when they heard that

      1. Eldritch Office Worker*

        A week, in 2022? Eh. The amount of people dealing with furloughs, cutbacks, RIF, and underscheduling since 2020 is not insignificant. This is a pretty minor impact overall.

        I know a week of pay is a significant loss to a lot of people and I don’t want to undercut that, but there’s a lot of context.

        1. Manic Pixie HR Girl*

          I also wonder if this is because there was an overwhelming number of people with a huge accrued PTO balance from not taking any time in 2020 and 2021.

      2. stacers*

        I had to take a week of furlough in each of the three summer months in 2020. But we were able to claim unemployment for those weeks, and with the enhanced rate at the time, many people saw almost no dip in pay. And the company is healthy today

      3. brett*

        Is it weird that I would love a random unpaid week off? I’m fortunate to not be living paycheck to paycheck.

        Maybe they should let employees choose. I’d gladly take a week off unpaid to save 5 other people from one forced vacation day they didn’t want.

    2. NotRealAnonForThis*

      Meh. My spouse worked somewhere where they were forced to take a week in December if they were salaried, then a two-week shutdown for everyone.

      What actually happened was that everyone salaried used the entirety of their PTO (which was 3 weeks or less, btw) prior to the “Salaried Employee Mandatory Week off”, took the salaried employee week off with no pay, then filed for unemployment benefits with our state for the two week shutdown. Under the rules in our state at that time, the way the company structured their December, well…a week off due to a shutdown or otherwise employer directed that led to no pay made you eligible for unemployment.

  9. TheBunny*


    They are absolutely trying to get the unused vacation off their balance sheets.

    When I left my last position, I cashed out 240 hours of PTO. Without getting into pay specifics, my husband and I used the money to spend a week in Zurich.

    Depending upon pay bands, those hours could add up to a substantial liability for the company…because of people literally like me. (In my defense…I was saving my PTO for a longer 3 week trip later in the year and accrued 5 weeks per year when I left so it wasn’t me not taking time off for years.)

    1. AngryOctopus*

      I got a huge vacation payout when I was laid off in 2019 because 1-we got a good amount of vacation, 2-I was planning on taking vacation basically all of August as well as time in March and 3-they paid out the 2 “sabbatical” weeks I got as a 10 year bonus, so I got all the regular vacation days I was saving up plus those two weeks. But I don’t bank my vacation “just in case” or for a payout. It was just a happy coincidence.

      1. MistOrMister*

        I was laid off last year and was absolutely livid that they only paid me 2 weeks of leave. I had more days banked but they only paid up to 2 weeks which felr like a slap in the face.

  10. Pseudo Anon*

    lw5: how on earth is taking time off “sticking it” to someone?! Particularly for those who have earned/saved up 7.5 weeks of vacation (300hours at a 40 hour week)… I’d say this is a reasonably people friendly policy.

    1. General von Klinkerhoffen*

      Yes, as I read the letter I was expecting them to be enforcing much longer absences (measured in weeks, not days) as the mandatory PTO will barely make a dent in those banks.

      It feels kind of BEC, like maybe it’s incredibly difficult to take time off in practice, or everyone is already working unpaid overtime, etc.

    2. Lady Lessa*

      If your company is small or a small division in larger ones, folks may not have good back up people to cover for them. Something similar is happening to us (and the overall conglomerate is posting record earnings). At least one vital person is taking 2 days a week because we will lose all but 40 hours at the beginning of the next fiscal year.

    3. kiki*

      Yeah, I’m also confused. I suppose maybe a lot of folks at LW’s organization were viewing vacation balances as a way to get a payout upon departure rather than a means to take time off of work while working? Or maybe a lot of people were saving to try and take a month or months-long breaks?

      1. Momma Bear*

        In some industries (say federal government) it’s common to do just that – bank everything you can right before you retire and cash out.

        If people are banking a lot nowhere near retiring, I think that points to a bigger problem. I’ve worked for companies that complained about people not taking leave, but ran such a skeleton crew nobody COULD take leave. You can’t have it both ways.

        1. ferrina*

          That’s possible- I worked on a team where I would end up working on every ‘day off’ because there was no coverage. If this is the case, this is an issue. But it is a separate issue from management trying to get high PTO accumulation off the books

  11. Emmy Noether*

    I don’t really have a problem with forcing employees to take their leave (I’m used to a “use it or lose it” system and no payouts, and I like it that way). What would annoy me is that with this plan, it’s fractured. One day here, one day there. I like my summer vacation in chunks, to travel.

    Though if the company is in real danger of going under, it may be a good idea to take the PTO now anyways – don’t know if it’ll be paid out, and when, if they go bankrupt. You can even use the days to job search.

    1. Glitter*

      Then they can book a chunk of time off in the summer – the one day is a minimum, it’s not stopping anyone using their vacation time normally.

      1. Emmy Noether*

        yes, but if they, say, took two weeks in August, they’d ALSO have to take the day in June and the day in July. The mandatory days aren’t groupable, they’re spread out (especially as this year there are no workweeks spanning June/July or July/August). People won’t take a chunk off in June, and another chunk in July, and another in August, so there will still be some single days off.

        1. Elsajeni*

          Sure, but I think “a single day off at a time, although it in no way prevents me from taking a longer vacation later, is not the way I most prefer to spend my vacation” is pretty far from “sticking it to me,” you know? The minimum someone would have saved up to be affected by this policy is 2.5 weeks; taking the one mandatory day in May still leaves you with your 2 weeks to take in August, if you like, or you could take 2 weeks in May instead and knock it out of the way, and either way you’re below the threshold for required vacation in June and July so you don’t have to worry about it. You could also, as a few other commenters have mentioned, talk to your manager in advance and say “hey, I’d like to take a 2-week block off in August, if I book that now will it count as ‘spent’ so I don’t have to take these mandatory days in May and June?”

    2. Managing While Female*

      I don’t think there’s anything in the policy forbidding them from taking a week or two off. In fact, I’m guessing they would welcome it so that people start actually using their PTO. I think that’s the purpose behind this policy.

  12. learnedthehardway*

    OP#2 – how would you want your coworkers to treat you, if you were in the same situation? You would be upset that they informed your manager that you were job hunting, right?

    You don’t owe it to an employer to inform them of your coworkers’ career decisions/plans.

    As a recruiter, I have had clients who expected me to tell them if I come across their employees’ resumes on job sites. I didn’t and won’t. It’s not any of their business. The companies should have contingency plans for if someone leaves, the same as they should have contingency plans for if someone gets hit by a bus. Companies have disproportionate power in the situation.

    Besides which, what it the employer going to do? They can either let the person go first (which is a crappy thing to do, but does happen), or the person may leave on their own, OR the person may decide NOT to leave. At which point, your manager is wondering what your motive was in informing on the coworker. Did you want to have them fired? Did you want their role? Do you have personal axe to grind? Even if the employer expects you to tell them about your coworker’s plans (which is pretty good evidence of a toxic work environment), they will not trust you over it. And you don’t want the reputation of someone who betrays coworker personal information – other coworkers won’t trust you.

    I would stay out of it entirely and forget you hear anything.

    1. OP2*

      Hi #2 here,

      What you said here:

      > Besides which, what it the employer going to do? They can either let the person go first (which is a crappy thing to do, but does happen), or the person may leave on their own, OR the person may decide NOT to leave.

      is the reason why I didn’t say anything, because ultimately, the most benefit possible would have been a couple of weeks’ headstart on filling the potential vacancy, which would be hard to justify as the position was then occupied.

      As for how I would want others to treat it… Look, I would hope that they would say nothing, but I would never expect it, and personally, if I had been applying for jobs and a number I didn’t recognise popped up, there’s no way I’d answer it while on a call with someone else, not even if I’d thought I’d muted myself!

  13. leif*

    i just wanted to thank OP 1 for how much they care. i have PTSD, grew up experiencing pain at a dentist who used shame tactics, and am extremely kind and understanding to all service providers but my autism means my tone often comes across as rude or blunt if i express anxiety. i hope i can find someone with OP 1’s level of inclusivity and compassion when i eventually get up the courage to go to a provider again (I am NOT looking for advice). I also want to say that I read “I might hit you” as referring to reflex thing as well, maybe even getting so anxious that they didn’t even think about saying it – but it’s not acceptable for them to pretend like they didn’t say it, it’s not an okay thing to say and it’s on them to manage their anxiety, and it sounds like you were very accommodating and they may not be ready for the procedure even with accommodations. I think Alison’s script is very reasonable. I think any way to flag that what the patient just said is enough to halt the appointment, even just asking if they need a break, or repeating the words as a question to see if they can offer further commentary on what they mean. Finally, it’s okay that you did let it slide, OP! I am so familiar with only thinking of what to say after the situation is over. If that patient returns to the practice, is there a way to bring it up? “Last time you were worried about possibly hitting me. Is that something you genuinely think is a concern? If so, I’m happy to find a different provider here that might be more willing to work with you” – this phrasing isn’t exactly right, but just so you know – it is not ever too late to address something that operates as a threat even if it wasn’t meant as one. You sound like you’re wonderful at your job and I’m sorry that happened. How intensely stress-inducing for you, even though you are giving them even more grace than is necessary.

    1. LW1*

      Leif- come be my patient! I would love to take care of you! You sound like a delight- rude and blunt don’t bother me at all, one of my very favorite patients starts each visit by reminding me how much she hates me, and ends each visit with a huge hug. Promise you won’t hit me and I’ll happily be your hygienist!

  14. Elsewise*

    LW4- I once hired someone (college student) who had on her resume that she answered the phone throughout her shifts. Only she dropped an “f”, and in doing so, raised some questions about where she was taking these work calls. I had no idea if I should raise it or not! Eventually she mentioned to me in private that she was applying for another job (normal, it was a very part-time position) and I felt like I had to bring it up. We were both mortified, but had a good laugh! I assume she updated her resume, although I never did get that reference call.

    1. Onwards and Forth*

      I interpreted “dropped an f” as in “dropped a swear word” and struggled to understand this!

      Once I realised that you meant she dropped the letter “f” from the word “shift” on her resume it made much more sense!

      1. metadata minion*

        Me too! And ohhhh, the second-hand embarrassment, as someone who has also made that mistake.

    2. FashionablyEvil*

      It’s a kindness to bring things like that up. Embarrassing in the moment, but much better in the long run.

    3. Two Dog Night*

      Ages ago my husband and I were staying in a hotel, and he bought a package containing a water bottle and t-shirt. This showed up on our hotel bill as WATER BOTTLE AND SHIT. He pointed it out to the manager, who at first was furious that an employee typed that into the system… and then realized that they’d left out an R.

      We still laugh about it 10 years later.

      1. AnonORama*

        That’s awesome! I caught the phrase BUDGET SHITS (also dropped an F) in a slide deck for our Board years ago and became the presenter’s favorite person for quite a while.

  15. Brain the Brian*

    A much more business-first-employee-last move for LW5’s management would be to simply cap the amount of vacation that can be paid out if an employee leaves at X days. That they’re instead solving their liabilities issue by forcing employees to go enjoy time off is certainly not “sticking it” to staff.

      1. Eldritch Office Worker*

        Not in that exact wording, but you can cap rollover so that employees can only accrue up to a maximum amount of PTO.

        1. AngryOctopus*

          Yeah OldJob capped at a year’s vacation days, and also wouldn’t pay out days on a rolling basis so a person could keep earning (I don’t know if that’s a thing, but I do know that a couple people asked, which is why I mention it). They specifically said this is because they wanted people to actually use their vacation days and take actual time off.

        2. Leenie*

          It’s dictated by law in California. We can accrue up to 150% of what we earn in a year, and then stop accruing until we go below that balance. I’m guessing it would be legal to force us to use some of it. But it wouldn’t be legal to say that I could only rollover 40 hours, or anything that’s below 50% of my annual accrual.

          1. Leenie*

            Sorry, I should have said under 150% of my annual accrual. I’ve been at my company for a very long time. I earn about 7 weeks a year (it’s PTO – no separate sick leave), and don’t stop accruing until I‘m over 10 weeks. I do stop accruing at times, but don’t sweat it because it’s a generous policy. The company couldn’t suddenly say that I can’t carry that much time over, as it would be illegal in CA.

            1. H.C.*

              That’s very much not true, I work in California and my PTO (well, vacation & holiday) cap is 3x my annual accrual rate (I accrue 23 days per year and the cap is 69 days).

              1. Leenie*

                Yes, it can be more than 150%, and it’s nice that yours is. But the legal minimum is 150%.

              2. Leenie*

                My point was just that they can’t put on an arbitrary cap, if that cap violates the law. My company isn’t violating the law, yours is well exceeding statutory requirements.

                1. H.C.*

                  Ah I misread & my apologies – thought you meant the cap can’t go over 150% accrual rate

      2. doreen*

        The way I’ve usually seen it is that once you hit the limit, you won’t accrue any more until you use some. They don’t take any away , you just stop earning more.

      3. Allonge*

        But that is more or less the point – just about any other solution to this problem the company has is worse for the employees.

  16. Aardvark*

    #5 If the forecast results are poorer than previously expected it is actually a good sign that the company is looking at home to manage their finances in a way that only has a small impact on their staff. It would be worse if they didn’t do things like this and then started making people redundant to cut costs instead. They aren’t trying to stick it to you, they are trying to save the company.

    Enjoy your day off. Sleep in, read a book, catch up on the laundry, visit a friend. Book a Monday or Friday and make a long weekend of it.

    1. Simona*

      I’m so confused why this would be “sticking it” to anyone anyway? Ohhh nooo, not mandatory vacation day. Am I missing something about this?

      1. Hlao-roo*

        The only two reasons for the “sticking it” feelings I can think of are:

        (1) The employee has a general feeling of “vacation days are mine to do with as I please.” And now the company is telling the employee “you must use one vacation day in June” so the employee’s emotional response is “you’re not the boss of my vacation days! I don’t want to take vacation in June!”

        (2) The employee has mentally decided their vacation time is going to be used for a specific purpose (a long vacation later in the year, as an insurance bank if they ever get a protracted illness and burn through all of their sick time, as a payout for unused vacation time if/when they leave the company, etc.). And it feels like the company is saying “you can’t use your vacation time for the reasons you want to, you have to use it for the reasons we want you to.”

        Personally, I’m with you. If I had 100+ vacation hours banked, I’d happily take off a day with great weather in the summer to laze around the house, or go for a day hike, etc.

        1. Sola Lingua Bona Lingua Mortua Est*

          Personally, I’m with you. If I had 100+ vacation hours banked, I’d happily take off a day with great weather in the summer to laze around the house, or go for a day hike, etc.

          June plus Summer would be the part I would object to. Take a day in May or October? I’ll make it a week and pour my efforts into my hobbies! A day in January or February? I’ll make it a week and enjoy the crisp, brisk outdoors! But in the summer, it’s just a doubly-wasted day–a day I fall behind my work and a day I want to take later that I no longer can.

          We don’t all worship Sol Invictus.

          1. Silence*

            I think if they took enough time off now to get them below the threshold they wouldn’t need to in June,

        2. But what to call me?*

          I guess a third reason could be that it’s a place where it’s hard to actually take vacation days even when told to, or that the employee is someone who struggles to take them. It could be a job where taking a day off just means you have to cram more work into the remainder of the week or take a bunch of work home with you or shift work onto overworked colleagues.

          At my last job, I could have either picked to take off a paperwork day, in which case I’d still have to find time to complete the same amount of paperwork, or a client day, in which case I’d have felt guilty for making my coworkers take on that extra work (seeing clients plus the substantial paperwork that came after each client). I still wouldn’t call making people take a day off during that time sticking it to us, though. The sticking it to us part was leaving us understaffed for almost a year for reasons even our coordinator couldn’t determine. No PTO policy was going to fix that.

    2. Knope Knope Knope*

      Yeah. Honestly sometimes employees don’t see the forest for the trees.

      I used to work at a media organization where a lot of the writers wanted to write longer “think pieces” and our usually hands-off editor tried implementing quotas to get people to write more stories more frequently. The writers felt it was unfair and banded together to push back.

      Well, they got their way. But we weren’t able to maintain enough readers/pages to keep the business afloat and many of them lost their jobs.

      This reminds me of that. Sometimes an employer wants to offer something and the economy makes it impossible. I would be job hunting and taking my mandatory time off if I was OP, not advocating for a policy that risks the financial solvency of their company.

      1. Jessica Clubber Lang*

        If the solvency of the entire company rests on a few vacation days, I’d say the employees are more than justified in being upset about the entire situation

  17. londonedit*

    I agree that the patient in OP1’s letter came across as threatening, but my first thought was that it was a misplaced/nervous attempt at humour. Maybe it’s because I’m British, but we tend to have a very ‘gallows humour’ sort of approach to things, and I can imagine someone in a nervous and stressful situation might make an ‘I will hit you, remember!’ joke. They probably don’t mean it literally, it’s just an awkward way of trying to express the fact that they’re scared. Of course, it’s not acceptable for people to threaten those who are trying to help them, so I think in OP1’s case they could definitely have responded with ‘I know you’re nervous, but you can’t say you’re going to hit me even if you are just joking. If you really think you might lash out, then I can’t continue this appointment and we’ll have to reschedule so that you can look into managing your anxiety’.

    1. Eldritch Office Worker*

      In all likelihood, I agree with you that’s probably what it was. But medical professionals deal with real violence all the time, and OP can’t take it as anything other than a legitimate threat. The same way there are many types of pranks that we have to take seriously and have lockdowns over because the risk of it not being a prank is too high.

      1. Boof*

        Yep, I allow 1 joke and have the “you can’t joke about bombs at the airport; you can’t joke about violence against medical staff” conversation – if they continue, it’s a behavior management plan. Afraid those kind of jokes have to be addressed /taken seriously because it’s a real issue we deal with.

  18. Educator*

    Worrying about when you have to take your vacation days when your company is obviously struggling and concerned about paying people out is really rearranging deck chairs on the Titanic. I hope the writer is seeing this for the huge warning sign that it is and planning their next move!

  19. Lurking Reader*

    #4 – it was over 20 years ago that I was shown an application where someone had written “I can carry out most tasks given to me as I take pride in being highly volatile.”

    Versatile. The word you’re looking for is versatile.

    We never reached out to the applicant, but have I *frequently* used it as a specific example to colleagues and friends over the importance of proofreading, over the years? Oh Yes.

    To be fair, the context was clear and we definitely didn’t think the applicant was saying they were proud of being volatile, so in its own right wouldn’t have affected the application. I guess it does show poorer attention to detail, but we felt it not worth reaching out to correct them. We just laughed, shrugged and moved on.

    1. bamcheeks*

      I had a Microbiology candidate who said they were proud to be involved in the eradication of human, and I was like, I’m hoping you meant to have the word “diseases” at the end of that sentence?

      (Although I also feel like the total eradication of human diseases would probably have unintended and unwished-for consequences.)

      1. Sloanicota*

        I suppose the eradication of humans would also eradicate a lot of human diseases, but I can’t say it’s the most efficient way to go about it.

        1. Be Gneiss*

          It actually might be the *most* efficient way to go about it. Otherwise you have to eradicate one disease at a time.

          1. bamcheeks*

            Actually a pretty great example of how the most efficient solution may not always be compatible with the mission statement and core values…

          2. Hastily Blessed Fritos*

            Yeah, that’s a total evil genie / monkey’s paw approach to “I wish all human diseases were totally eradicated” right there.

    2. Seeking Second Childhood*

      For our editorial assistant opening, one resume listed “poofreading” experience.

      With 100+ applicants, they did not get an interview.

      It did give us an idea for an interview question about process for checking your deliverables.

  20. I should really pick a name*


    Do you have other issues with your employer?

    Otherwise, I have difficulty understanding how this could be viewed as sticking it to employees.

    If you have 200 accrued hours by the middle of the year, you either have a very generous vacation allotment (by US standards) or you’re not using all of your vacation in the year you accrued it.

    Requiring up to 3 days to be used isn’t punitive. Even if the company was in good financial shape, it would be reasonable to require all vacation to be used in the year it was accrued.

    1. H.Regalis*

      Yeah, I’m not seeing that either. You’re getting paid for the vacation days, right? And the pay is the same for a vacation day and a work day? If that is true, then I don’t see how they’re screwing you over.

  21. Morning Reading*

    LW1: I don’t have a better script for you but I will suggest that stepping back, physically, out of reach of a patient who makes such a statement would be a good idea, while you discuss it.
    I have an unfortunate reflex sometimes when I’m in pain where my right foot suddenly kicks out. I do warn dentists and gynecologists about it, just in case. Dentists less likely to be in range. So far I’ve never kicked anyone. I wonder about this patient’s statement: could it have been meant as a warning or caution, not a threat?
    Would it be possible to strap this patient to the chair, making it impossible to strike out? It doesn’t seem wise to hit someone holding a sharp object in your mouth, so if it was a warning about a reflex, maybe patient would be open to such a solution.
    But whatever you choose to say, do it from a distance.

    1. unpleased*

      Strapping seems like entirely the wrong response. My mom was a psych nurse, and restraining a patient that way is something that they would only do in extreme circumstances. She was hit and almost strangled by patients, to put that in context.

      1. Simona*

        Yeah, there are sedatives that people can have to make them not panic. I feel like there are several practices close to where I live that offer this. It’s not rare so it’s interesting the patient hasn’t taken advantage of this as its MUCH better for everyone.

        1. kalli*

          In most dental practices I’ve been in, cleaning doesn’t usually get anaesthesia or numbing or even an assistant. Actual dentist doing dental work – at least local anaesthetic, and at least one assistant.

      2. metadata minion*

        It would be reasonable with consent — if I’m going to lash out reflexively I’d much rather you just secure my arm than try to worry about containing the reflex. I wish the stupid puff-of-air glaucoma test had a way to just hold my eyelids open, because I have an incredibly strong blink reflex and it’s almost impossible to get a good reading. But that’s me, and other people won’t necessarily feel the same way.

  22. Also-ADHD*

    LW4’s point about tense is one of my great resume frustrations. I usually resolve it by making everything past tense even on my current job (though I’ve had folks ask with confusion if I’m still there). But the reality is I have things that should be past tense (achievements from closed project’s /duties that change to project needs) and some that should be present. And I hate mixing them too but I hate when it’s inaccurate as well (even in ways that don’t matter). It’s very annoying.

    1. ecnaseener*

      Their example was about a previous job though, so everything should be in past tense. I don’t think there’s anything wrong with mixing tenses when talking about a current job — you can’t avoid it if you want to address both duties and accomplishments.

  23. HannahS*

    OP1, I’m a medical provider and often provide safety teaching to junior learners, because we work in an environment where being assaulted by patients is a real possibility. A few points:

    1. Addressing this kind of thing is hard and takes practice. Don’t fault yourself for not knowing what to do in the moment. Almost everyone I know (including me) has done the same thing as you.

    2. The second someone threatens violence, the interaction stops. The issue isn’t that threats are disrespectful, the issue is that they might actually hit you. You don’t wait until someone starts being violent–that’s too late, because even if their intent is even just to grab your arm, they are striking out at someone and there are sharps everywhere.

    3. I agree with Alison’s script. Someone who is uttering threats is telling you that they have feelings that they can’t control, so you need to listen to that and keep both of you safe. An alternative that I often use when I do want to try and continue the interaction is to calmly move back and say, “Wow, I can tell this is a lot. Let’s press pause. What’s going on for you right now?” “We can’t continue this if you feel like you really might hit me. Do you want to try again another day?” And maybe this specific person could have expressed that they need five minutes or a drink of water and been fine. But your threshold to end the interaction should be low. Practically speaking, this person might just not be able to endure dental cleaning without a sedative, and they can talk to their doctor or find a dental clinic that offers that.

  24. elodieunderglass*

    I’m sorry that happened to LW#1. Some very gracious tips and tricks to handle the situation will come from midwives, nurses and people who work with children – i.e. professionals who are used to managing situations where people are distressed and reflexive. “I can’t let you hit (me/others). You may do (other options to manage distress)” is such a common saying in other fields that you will find it becomes instinctive with practice.

    I am a nice pleasant person with very good control of myself, excellent disposition, easy to handle and with high pain threshold. However, at one point in my career, when receiving stitches without anaesthetic, I regretfully and lovingly informed the midwife that I was on the point of (reflexively) kicking her in the face. She took it in her stride, asked helpful questions, and sorted it out. A student used pillows to provide better support and held me down in the nicest possible way, and another midwife held my hand and told me I was brave. I felt extremely comforted and in control, and everyone arrived at the desired outcome. I think a key component of this is that midwives are extremely outcome-oriented, and recognise that people can’t always be reasonable and professional when they’re in real distress; coldly telling a person in labor to get their trauma response under control, or whatever, is considered unsympathetic, and not especially helpful for parent or baby. Regardless, their strategies are good.

    Other nice tricks that midwives know include giving you a hand to hold, or something to pull, or even offering to lightly support/restrain the body part in question. (They’ve told me in the past how kicking in particular apparently just needs a pillow under the knee.) A particularly interesting trick is offering you something to bite – it’s amazing how much biting down can help people and animals to focus and manage their reflexive responses to pain and distress – but unfortunately not an option for dentists.

    It is also extremely good to be told you are being very brave.

    To keep the dignified mystique of dentistry, you could say coldly, “I can’t let you hit me. I can offer you a ball to squeeze.”

    1. Anon for now*

      Anonymous for this one because it’s not my story. When my wife was getting her IUD inserted, her gynecologist warned her “You’re going to want to kick me in the face. Please try not to.” (There’s a lot to be said about gynecological medicine having inadequate pain management, but that’s even more off topic than this already is.) Having that warning was really helpful for her.

      1. Be Gneiss*

        My provider now offers nitrous oxide for pretty much all procedures, and after having a couple different biopsies over the years, I’m glad to see that as an option. Interestingly, they added that at the same time that the last male doctor left the practice.

    2. Boof*

      That’s a good point, it’s a bit different when dealing with someone who lacks capacity or has no credible threat (ie, a child, someone who’s disoriented because of meds etc); still kindly inform them they can’t hit and offer them an alternative ie squeeze hand, stress ball, etc.

  25. Meg*

    I’m a vet and I’ve been threatened a couple times by grieving clients who called ME to euthanize their pets. I was not part of the decision at all, but they like to take it out on an easy target. If anyone gets angry or violent before the appointment I will leave. Unfortunately they usually wait until the pet is sedated or gone and I’m not allowed to abandon a sedated pet unless my life is in danger. It’s still completely unacceptable to treat any professional this way and we will absolutely fire you as a client for it.

    1. CommanderBanana*

      I am so terribly sorry. When my beloved dog passed, the woman who came to perform the euthanasia was so wonderful, and so kind and just a loving presence with us in a such a sad time.

    2. Texan in exile on her phone*

      I’m so sorry. We had to put our beloved cat to sleep and the vet who came to our house was amazing. We were so grateful for his kindness and that of the tech. How awful to be doing such work – which is already emotionally fraught – and then to be treated badly.

    3. Kit*

      Oh, I’m so sorry – we had to make that call with our geriatric cat just after Thanksgiving, and the emergency vet staff were all incredibly kind about it! I was a complete mess, but they made a difficult situation as comfortable as possible. I can’t fathom what goes through some people’s minds, but thank you for doing what you do for vulnerable and suffering animals.

  26. Hastily Blessed Fritos*


    Does your practice have policies about unacceptable patient behavior? If not, can you suggest developing some, so that they are consistent and enforced? I’ve seen quite a few medical providers over the past couple of years, and all of them had clearly posted policies, with the explanation that depending on the severity they would mean cancellation of the appointment up to being banned from returning to any provider in the system.

    1. warm smile in your voice*

      That’s what I was wondering. I’m not sure if dental hygienists are considered “independent contractors” in a dental practice or part of the staff like other personnel but either way, LW1 should loop in their dentist and coworkers if they haven’t already. The practice might already have a policy in place for this type of situation. Or this might be the impetus to create a formal policy. Or LW will learn that the policy is “deal with it or find a new job” which sucks. But it’s better to find that out before the patient hits you and then your employer hangs you out to dry as well.

    2. TPS Reporter*

      OP is doing such a great job on their own, but I was also thinking that they should be able to reach out to management/other co-workers for help. They sound like an awesome hygienist and super thoughtful. I hope the practice can provide them with more support in these situations.

  27. Crooked Bird*

    LW1, don’t beat yourself up for not saying anything direct about the inappropriate comment. A person can tell when their comment sucks all the air out of the room (and from your description it clearly did!), and sometimes it feels even worse to them than when someone calls them out. When someone calls you out you can argue with whatever they said. When someone has a purely natural, real response of emotionally pulling back from you… you gonna argue with that? How?

    1. Czhorat*

      I completely agree. It’s SO easy to get caught flat-footed when someone says something way out of pocket and not come up with the right answer until much later. It’s universal enough that there’s a a phrase for it – in French it is referred to as L’esprit de l’escalier – loosely translated to “staircase wit”. You get the right answer after you’ve left and reached the bottom of the stairs, when it’s too late to say anything.

  28. Elinor*

    I’m a dentist and have heard many variations of “I’ll hit you if you hurt me.” I’m flabbergasted every time. Thank you for the script, Allison!

  29. hmmmm*

    The dental hygienist likely doesn’t have the authority to single-handedly terminate a dental patient’s visit. Hygienists are the low rung of dental practice. They typically aren’t making decisions on which patients can stay or need to be referred out to another provider. If they are really trying to solve the problem of potential harm in delivering service, they need to speak with their own boss–the dentist–about how to handle outlier cases, even when all their techniques at calming a patient aren’t enough. The most they could really say without dentist buy-in is “that would not be okay.”

  30. Bast*

    #2 — I’d caution against assuming anything just based on what you heard. Clearly, this person was looking because they left shortly after, but in my experience plenty of people work side jobs, or it may have even been a job they applied at a good long while ago. Case in point: I was interviewing last year, applied for a job in February, accepted a different job in April, and heard back from the February job in October. OCTOBER. I had forgotten about it by then. Having worked in plenty of positions where people get canned when management even gets a whiff that they are looking, I’d hate to be responsible for someone losing their job over what could be not having enough context.

    1. fallfromfaith*

      This happened to me, too, just last week! I was job-hunting in September, sent out a few resumes, and accepted a job in October. One of the other jobs just called me last week on May 2nd to ask if I was still interested in employment! It’s been nearly a full 9 months.

    2. OP2*

      Hi, OP2 here.

      A second job! I’m even more grateful that I had kept my mouth shut, that hadn’t even occurred to me at the time! Imagine if I’d ratted them out, and they were just looking for some weekend work or something.

      Thank you!

  31. HailRobonia*

    #4: I’m imagining an ancient hero sailing between the the The Perils of Autocorrect and Pitfalls of Spellcheck. I once sent out a scientific seminar flyer that listed the speaker’s position as “Principle Investigator” (should have been “Principal”).

    Also, make sure your contact information is one million percent correct… I go through periods where I get voicemails from various companies for an individual whom I don’t know… they are like “This is a call for Phillip J Fry. We’ve received your application and would like to schedule an interview…”

    The first time I got one, I thought it was some sort of scam. Then as I got more and more, from companies I’ve heard of, I came to the conclusion that Phillip J. Fry either had my phone number in the past, or messed up the number on his resume. For a while I called the companies back and explained I had no idea who he was in hopes they would alert him to the wrong phone number (at first out of compassion – this guy is missing his opportunities, but then later out of annoyance – I am sick of getting these calls).

    Fast forward a few years, and every once in a while I get another call about him. My working theory now is that he is on unemployment and is applying for jobs with fake contact info so he can say he’s actively job hunting.

    1. Delta Delta*

      Or poor Philip J Fry is missing a ton of calls because his number is one off your number. When I was in college my dorm phone number was one digit off the university hospital’s eye care clinic. If my number was 693-3188, their number was 693-3318. It was so easy to mis-dial, especially for folks with eye problems.

    2. Ama*

      It’s possible if he typed it wrong in a job application portal at some point it might still be autofilling wrong if he doesn’t pay attention. I regularly get emails in Dutch — there is apparently some person in the Netherlands with a similar name (this was confirmed when I got an email with his name on it — you could easily get something similar to my gmail address out of his name).

      I am pretty sure it’s an autofill issue because I’ve never received anything but automated messages and marketing emails (although for a bit some of them were appointment reminders from a medical office which was concerning, but he must have corrected it with them because those stopped) — I sometimes wish I’d get an email from someone who really knows him so I could ask them to tell him he’s typing his email in wrong!

      1. AnonORama*

        Ha, I get a lot of wrong calls too, but not for job interviews! Either my number used to belong to some dude named Larry who has serious debt issues — with businesses and some sketchy-sounding individuals — or he randomly chose it to fake people out years ago. (I don’t know anyone named Larry, so I can’t imagine it was done deliberately. The number is super easy to remember, so I can see why it would pop into someone’s head.)

        I was getting so many calls for a while there that my voicemail message was “Hi, you’ve reached [Anon], not Larry…”

    3. Kit*

      Is it the Philip J. Fry from Earth, or the Philip J. Fry from Hovering Squidworld 97A?

      I get calls for a ‘Thomas,’ despite having had the same cell number since ’02, so typos or deliberate wrong numbers do happen. I’ve reached the point of assuming that it’s a tank engine whose ability to type numbers is limited by his lack of hands, which gives me the mindset to dismiss the calls with more grace than annoyance.

  32. Czhorat*

    For LW#2 -not only is it highly in appropriate to tell management that a co-worker is job-hunting, but I have a small concern about this part of the letter:

    “”I had already expressed to my manager my concerns about their performance and skills. After this call, my manager followed up on this, and I reiterated my thoughts.””

    Were these issues that directly impacted you and your job? If not, I’m a big proponent of letting management manage and focusing on ones own work. If your coworker is having performance issues then their boss is being paid perfectly good money to identify and correct those; unless you have some kind of leadership role you might be happier if you stay in your lane and develop a blind spot for your peers’ performance.

    1. Sneaky Squirrel*

      Given that this co-worker has been identified as a teammate, I think we should give LW the benefit of the doubt that their performance and skills have some direct impact to LW.

    2. Rainy*

      I mean, I guess if their poor performance is impacting LW2’s ability to do their job, I can see saying “Hey, every time I get a Pirate Report from Coworker, I have to send it back for correction before I can use it, do they need extra training or something”. But yeah, as it’s expressed it honestly sounds like they have some kind of vendetta and were trying to get the coworker fired or something.

      1. OP2*


        I’m sorry I came across this way – I actually would prefer more people on the team, but not when I’m having to do their tasks for them, which is what happens here. I’m also a huge believer in giving people time to settle in and learn organisational knowledge, but this wasn’t what I observed to be lacking, in this case.

        1. Rainy*

          Telling management that someone is job hunting is such a big no-no that I was super taken aback that someone would even consider it, and I think a lot of other people were as well.

          I understand the frustration of dealing with people who can’t or won’t do their jobs, but the remedy there is to 1) address it with the coworker (“I’ve walked you through this a couple of times now and I really don’t have time to do it again. Please refer to your notes or the instruction document, or ask your manager to help”x1, then “I don’t have time; ask Sue”x infinity) and then 2) tell your manager that the Pirate Report is always late/riddled with errors and it’s affecting your ability to update the Pirate Spreadsheet and do Pirate Budgeting and let them handle it.

          It’s not to tell your manager that they’re jobhunting. However you might intend it, the impression it leaves is that you’re being petty.

    3. OP2*

      Hi, OP2 here

      I 100% agree on keeping in my own lane and letting managers do the managing (I don’t get paid to do it, and don’t want the stress of doing so unless I accept it).

      I provided feedback only because I had worked on deliverables where my teammate was responsible for part of the output, and where I had been reliant on their output to complete my piece of work. Because they had either failed to complete the work, or had required enough guidance (several times) that I may as well have done it myself, I felt it was appropriate to speak up.

      Note that in those cases, the feedback took into account the fact that people take time to learn organisational knowledge, and was more about the transferable skills which I observed to be lacking.

    1. OP2*

      Thanks Doctor!

      The feedback was entirely about impacts of their performance on my work, and it seems like I should have mentioned that.

  33. BluRae*

    I actually did hit a dentist once, but:

    1. I was a child
    2. He tried to fill a cavity with no numbing agent.

    I didn’t get dental care as an adult for many years because of him, but still think it’s still never acceptable to threaten physical violence against a healthcare worker.

    1. Eldritch Office Worker*

      I’m sorry that happened to you. I’ve gotten cavities filled without numbing before, but only as an adult with full consent (I think they once even got me to sign something) and usually at my own suggestion. I can’t imagine doing that to a child.

    2. Savor The Peelies*

      Yeah, I kicked a nurse once, but I was a young child, and I was getting a shot in my leg that made me jolt on instinct– and now I’m very careful about those things!

    3. iglwif*

      OMG D:

      My daughter once bit her dentist. But in her defence, she was three.

      (He was a paediatric dentist. As I was apologizing profusely, he basically went “Meh, it’s not the first time and probably won’t be the last.”)

  34. Fluffy Fish*

    OP 4 – I have maybe an unpopular opinions about mistakes in resumes and judging them as poor attention to detail…i don’t unless its absolutely riddled with mistakes.

    not everyone is good an grammer or word use – if that’s critical to a role, I will use the resume as a metric of that, but as attention to detail eh really depends. kind of like people who get the lyrics to songs wrong – our brains do funny things with words and sounds. then you factor in autocorrect. proofreading doesn’t always help either – brains sometimes see what they expect to be there and not everyone has someone else to proofread (or who is good at proofreading)

    and resumes are so fraught to begin with. there’s so much advice to sort through, updating for different jobs as necessary, etc.

    1. Eldritch Office Worker*

      I take resumes with a grain of salt too – but it really does depend on what role you’re hiring for

    2. iglwif*

      I think it matters a LOT what kind of role you’re hiring for. I did a lot of hiring for editorial jobs earlier in my career, and you really do want your copyeditors and proofreaders to demonstrate an ability to use words correctly, construct a grammatical sentence, etc.

      But I can imagine quite a lot of jobs where those things would matter very little.

  35. Jessica Clubber Lang*

    I’ve seen on this site where people say things like “at work, there’s no such thing as tattling” or something like that.

    Normally I would agree but what LW2 is thinking about would absolutely be tattling or worse. Either way, not your circus so best just to stay out of it

  36. el l*

    OP 3:
    Unless you are bringing something to their attention that is “my coworkers are unsafe” or “you’re doing something illegal” ….

    You’re doing well to get it directly heard 2 layers up from you. 3 probably won’t happen.

    1. Eldritch Office Worker*

      Yep. Even as a director, if there’s that much space above you reaching the top is unlikely the majority of the time.

    2. Hastily Blessed Fritos*

      Yeah. I’ll talk to my boss’s boss (a director; I’m a top-level IC, think “Principal Llama Groomer”) fairly regularly, but it would take a lot to go up another level (an EVP) and I can’t imagine situations that would require me to directly go higher – maybe to an equivalent level in another org (the head of HR, or Legal), but not to the C-suite!

    3. Dinwar*

      Would the person that high up even be able to do anything about the issue? Where I work my boss can, but his boss isn’t in a role where he can do much about anything I’m going to encounter daily (except to have my back and tell me to take care of it). My boss’s boss’s boss would probably need three days to wrap his head around what I’m even saying–his role is completely different from mine, with completely different requirements starting at “What degree did you earn?”, and there’s no expectation that he’ll understand my role (that’s what my boss and I are for). And I’ve found that to be pretty standard in large companies–get high enough up and you stop dealing with people trained to do the work, and you start dealing with people trained to manage a business.

    4. Alan*

      Yeah, jumping three levels risks being seen as disrespectful to the people in the middle. I’ve actually done it but didn’t get a response and honestly didn’t expect one. I did it only so that I knew for myself that I had done all I could.

  37. Pool Noodle Barnacle Pen0s*

    “If you hit me, I will press charges for assault. I’m ending the appointment here because I feel unsafe. You may reschedule with another provider if you choose. Have a nice day.”

  38. Boof*

    LW1, I’m a physician, we have a little bit of training on how to handle this. Very haphazard training but some.

    First up, for LW and everyone, it is never ok to threaten anyone, and definitely not health care workers, with physical violence/retaliation. You can advocate for yourself, you can tell your team you’re scared or unhappy about something, you can report to patient safety, to patient relations, to the police, to lawyers, to medical associations, to google review, whatever you think isn’t right, but you can’t threaten to assault etc anyone. You can’t even “joke” about it. We face a lot of high emotions and tensions, things are often life or death, we take “jokes” seriously.

    That being said, as the OP points out, it’s usually coming out of a place of fear and anxiety, and there’s ways of making it clear that it is unacceptable that are more likely to deescalate the situation than others. Obviously what is desired is deescalation + never threatening again.

    I’d highly advise starting with empathy understanding, stating the problem, how you will address it, then finishing with the “but it’s not ok to threaten me or anyone”. So, I’d start with “It sounds like you’re really scared” (the opening/empathy/stating the problem you think is happening. Consider pausing to see if they say the problem is actually something else). “I totally understand that and I’m on your side. I want to help you get what you need [can mention that you hope you’ve been doing well so far in this scenario where you’ve already established some rapport]”. Give them a chance to answer. “One thing though, you just said you might hit me” (pause, see what they say to that). If they say “oh I was just joking, I’d never hit you” you can say something like “I’m glad to hear you didn’t mean it, but we have to take all comments seriously because we face a lot of problems. It’s like the airport, you can’t joke about bombs on the airport; you can’t joke about hitting or violence with your care.” (see what they say to that). MOST of the time that will diffuse the situation. If someone actually doubles down and doesn’t agree to never make such comments again, or if they keep doing it despite saying they understand, they need a behavior management plan, and eventually firing if they don’t stop (he management plan outlines what they will be fired over ie any actual physical violence, 2 or more comments about violence, swearing at staff, yelling at staff, etc)

    Also, if someone is mad because the health care system is messed up, or someone made an actual serious error, always acknowledge and apologize for that and discuss how to address it. But that’s for other scenarios, not this one.

    1. Boof*

      Also, if they actually SAY “well I’m scared so I might hit you” then the response is something like “I hear you that you are scared, but we’ll have to stop until we can get that under control. It’s not acceptable to hit me or anyone, or for me to be afraid you’ll hit me. Do you have someone who’s helping you with this?” (honestly you or your boss / dentist probably know the lay of the land better than me; might be PCP, might be psych, might be the dentist can prescribe benzos or something prior to procedures if the patient has a driver, etc – might have to get back to the patient if there’s any specific advice beyond going back to their PCP to figure it out)

    2. Boof*

      Last thing, LW1, consider asking your office to have this kind of training once and a while, even if it’s only once when you come on, or once every 5 years, it helps a lot to know what to do when you face crazy situations.

        1. Boof*

          I’m so glad!!! Hopefully you don’t have to deal with again but, it helps to have a plan just in case!

  39. CzechMate*

    LW 1 – where is the rest of the Dentistry team in this? I agree with Alison’s language, but it also feels like when this happens, you should be able to turn to the staff and say, “Hey, this patient is not just nervous, they’re becoming hostile and threatening violence” and the person should be escorted out.

    I’ve worked in school/university administration for a long time, and sometimes we’ll hear teachers or professors say things like, “Well…this student was making threats in class, but I just thought I had to deal with it.” No. Absolutely not. First, the rest of the team would (rightfully) be appalled to know that you’ve had to endure something like that at work, and second, they’ll likely be concerned that the person will harm another hygienist or another patient. Third, it just makes the environment generally unsafe and unwelcoming for other people. If anything, you could be reprimanded for NOT telling the rest of the staff this is happening either in the moment or immediately after.

  40. Problem Patient*

    LW1: There is a reason I see a specialist dentist.

    I recently had a HCP ignore the warning and guidance in my notes while I was an inpatient in an emergency situation, that I had PTSD and a severe startle reflex and *specific* instructions about how to wake me up. In the aftermath, I spent a lot of time crying curled up in a ball afterwards and frantically apologising to *everyone*.

    Fortunately what happened had been witnessed, including the HCP’s deliberate choice to try and ‘stealthily’ take obs rather than wake me up fully before touching me. I don’t know what happened with her officially, but I’m currently very clear with medical professionals about the incident, what happened, and what I’m doing to avoid it happening again, and what I need from them to help in that situation.

    I think it would be worth clarifying with your Bosses, LW1, what to do with patients who are declaring that sort of trauma. Do you have a clear referral route elsewhere? Additional services that they could access, especially ones that might not cost them extra? A form letter then can take to their primary care to get an anti-anxietal med to take before hand?

    1. LW1*

      You are not a problem patient, and I am so so sorry that this happened to you. I’m very thankful that there were witnesses who vouched for you. I hope that you find the kind and compassionate care that you deserve.

  41. Sneaky Squirrel*

    #2 – Don’t report it. Your colleague deserves some rights to privacy for their personal life and should be given the opportunities to share their plans at their own preference. But also, your company stands little to gain but could make things a lot worse for your teammate with this knowledge.

  42. Olive*

    LW2, while it sounds like the coworker actually was looking for a new job, I have gotten spam calls starting with “I see you’ve applied for the position of…”

  43. Dr. No Abuse Allowed*

    LW #1 I’m a physician who own my own practice. I would dismiss this patient. My practice does not tolerate abuse of staff. No verbal abuse, no threats, no physical abuse. This was a threat. I expect my staff to report this type of behavior to me and would be upset if they didn’t. Notify your supervisor and if they don’t dismiss, explain that you are not willing to treat patients who threaten you and they’ll need to reassign this person. (They should dismiss them).

    1. I'm just here for the cats!*

      I wish the OP would have said what the tone of the voice was. Was it a threatening tone of voice, then yes I agree that they could dismiss this patient. Or was it more of the patient saying that they may have a reflux and hit the clinician. I don’t think it would be fair to dismiss someone because they have such bad anxiety that they go into fight mode. I think it would be fair to talk to them about options such as medication they can get before hand, or something like laughing gas which will sedate them enough so they can’t feel anything but are still away enough for the cleaning.

      1. GythaOgden*

        Let’s give OP the benefit of the doubt here — they know what was said and how it was said, and was left having to write to Alison about it.

      2. Boof*

        It’s worth trying to work with the patient as I’ve outlined in some of my above comments, but it’s a good point that LW1 should let their supervisor/etc know. If it’s repeated and can’t be addressed then yes, patient has to be barred until they can manage their fear/anxiety/whatever.
        Thank you Dr. No Abuse Allowed for protecting your staff!!!

  44. Jessica Clubber Lang*

    This may be tangential to the question, but for #1 is there some kind of sedative or anaesthesia that could be used? I know for kids they do this sometimes, though not sure how all that works with insurance, etc

    1. JustaTech*

      When I worked for Big State U I would go to a lab inside the hospital that was just past the Dental Fears clinic.
      That they had an entire clinic for this, in addition to the free-to-very-cheap dentistry student clinic, tells me that this is a pretty common and serious problem.
      I also know that my dentist (a total sweetie and very competent) is popular with folks who are trying to get back into seeing the dentist after a bad experience. Partly because he is very kind and gentle, and partly because he is generous with the nitrous (I’ve never asked because I’m fine without it).

      1. Orv*

        In all my life I’ve only been to one dentist’s office where they didn’t hurt me. (The dentist was a relative so I think I was getting special treatment.) Now he’s retired, and I’m terrified to go back to being hurt. I haven’t been to the dentist in 10 years as a result.

    2. HannahS*

      Yes, absolutely. Some dentists offer light sedation during all dentistry when requested. Otherwise, sometimes doctors will prescribe a one-time sedative.

  45. Parenthesis Guy*

    #5 – This is sort of bizarre. If I get 200 hrs of vacation leave a year, but only have 10 hours remaining, then my leave isn’t a financial burden. If I get 100 hrs, but have 200 hrs remaining, then my leave potentially is a problem. It should be based on leave remaining, not leave generated.

    It sounds like the company may be going bankrupt and wants to reduce its potential liabilities before bankruptcy.

    1. Hlao-roo*

      I interpreted “hours accrued” to mean “leave remaining,” not “total amount of leave the employee accrues over the course of a year.” The way I read the letter, it’s closer to your “get 100 hrs, but have 200 hrs remaining” scenario.

      1. I'm just here for the cats!*

        Yes I believe its people who have 100, 150 or 200 hours banked just sitting there. They are saying you need to use this now. I think the reason they broke it up between may and July was so that not everyone took the same time off, leaving some areas short staffed.

    2. fhqwhgads*

      The letter says it’s based on what’s already accrued, which is “remaining”.

  46. HannahS*

    LW1, the internet ate my comment, but in brief, I’m a medical professional who often teaches junior learners how to stay safe. A few points:
    1. Don’t be too hard on yourself. It’s hard to know how to react in the moment, and responding differently comes with time, knowledge, and practice.

    2. The issue isn’t that they threatened you and that threats are disrespectful. A threat is very important information; they’re telling you that they have a feeling that they can’t control and that neither of you is safe in that moment. THAT’s the issue that needs to be managed, not the fact that they said it.

    3. As soon as someone threatens violence, it’s time to change the interaction. You don’t wait until someone is actually starting to be violent–that’s too late. Even if their intention isn’t to cause you harm, if they start thrashing, hitting, or grabbing at your hand while you’re holding sharps, both of you are in danger.

    4. I agree with Alison’s script, and I would recommend ending the interaction. It’s possible that this is someone who needs a sedative to help them get through dental work, and that’s ok. In my experience, while it’s possible that they’d respond to Alison’s script with, “Ok then!” it’s also possible that they’d not respond well. Playing it out in my head, these are some ideas of how it could go.

    You: If you’re feeling so nervous/scared/activated that you might hit me, it’s best that we stop for today.
    Them: [No I wouldn’t really hit you/I just want to get it over with/No you have to finish it]
    You: In a dental office, it’s important that everyone feels safe, including me. I can’t work in your mouth with sharps when you’re feeling so nervous/scared/activated that you might hit me, because either of us could get hurt. Sometimes, people who feel that way benefit from either doing the work in smaller chunks, or talking to their doctor about having a sedative.
    Them: [You’re being so unfair/you’re traumatizing me/what about the cost/I guess I’ll never come back then]
    You: I’m sorry, but again, we’re going to end for the day. Let’s walk out to the front desk and you can decide whether you’d like to rebook with me or with someone else.

  47. Trout 'Waver*


    Why are you trying to meet with top leadership? You say you felt heard by your immediate boss. That’s the correct order of things. Going to your boss’s boss with the same concerns after you talked to your boss and felt listened to is out of line, imho. You’re unintentionally communicating that you don’t trust your boss to appropriately flag and escalate issues, which is an important part of their job. And then you’re compounding that by trying to meet with your boss’s boss’s boss about the same issues. You’ve also reached out to the VP of HR about these same issues.

    Also, I’d expect a director to be responsible for culture, workload, and morale for their department and not for the whole organization.

    1. Alan*

      Yes, it feels like an overstep to me too. I definitely wouldn’t expect a response.

  48. I'm just here for the cats!*

    #5 yes its legal, and why wouldn’t you want to take your compensation. That’s like not cashing your pay checks.
    The only problem I would have is if I was saving my time for after July. That’s when I would go to HR and explain that I have plans to use that time in August, and would ask not to have mandatory time off before then.

    1. Manic Pixie HR Girl*

      Right, and I mean if you had, say, a 2 week vacation approved and on the books for August and were in that boat, I am sure you could request an exemption from this. (And, if not, okay, I can understand the frustration, but it is unclear if the OP has even sought this out.)

      But, also, assuming 200 hours being 8 hours = 1 day, that still leaves you with 9 days/72 hours by the end of August (1 + 2 + 3 + 10), and that’s not accounting for any additional accrued time between May and September.

  49. Marzipan Shepherdess*

    LW4: The job applicant with resume errors: In similar situations, I’ve told the person that I’d found “typos” in what they’d written. This enabled me to point out the errors but to (pretend to) attribute them to mere typographical errors…an accidental slip of the fingers over the keypad. It accomplishes the same thing (identifying the mistake) but does so in a way that doesn’t embarrass the writer.

    1. pally*

      This I like. It’s helpful and kind.

      I had a bad experience at a 6-person panel job interview when the very first question was to question my fitness for the position as I’d misspelled “attention to detail” on my resume. Followed by peals of laughter.

      This really flummoxed me. Bombed the interview. That’s not a phrase I’ve ever used. How the heck did it make it onto my resume I wondered?

      “Attention to detail” wasn’t on my resume. I was being hazed.

  50. Carrots*

    LW5 I am at a loss to understand why taking one day of vacation when you have over 100 hours (!!!!) accrued is a bad thing. What a nice problem to have

    1. it’s gonna be bye bye bye*

      Agree, literally, it’s one day. You can think of something fun, relaxing, or useful to do with one day. At least in the US, it’s incredibly unlikely that you would’ve been able to take that full 2 1/2 weeks all in one go at some point anyway.

      You often see people say things like, “ I don’t want a random day off to waste watching TV.” I’m like… So don’t watch TV! Go to a museum, go, birdwatching, go to the library, go on a walk somewhere or you’ve never been before, go on a day trip. Do something interesting.

    2. Jessica Clubber Lang*

      I agree overall, but I also understand the perspective of the employees – nobody likes to be told how and when to use their time off.

      Plus this isn’t happening in a vacuum. Sounds like there’s financial trouble in the company, so the morale overall might not be so great right now

  51. Saberise*

    The wording means those with 100 hours have to take 1 day, those with 150 would have to take 2 days (1 in May and 1 in June) and those with 200 would have to take 5 days (1 in May, 1 in June and 3 in July). If that was not their intent it would say 101-150, 151-200 and over 200.

    May – all employees over 100 hours accrued take one day vacation
    June – all employees over 150 hours accrued take one day vacation
    July – all employees over 200 hours accrued take three days vacation

  52. Dinwar*

    #1: I think there’s a difference between a threat and a warning/explanation.

    I know people who’s reactions to certain things are to flail around wildly–in a few cases, bad enough that they went to neurologists to figure out what was going on, because they’d collapse and have left significant bruises on people from their flailing. And if you’re in dentistry by definition you’re going to be within striking distance. If that’s the case, I personally would rather know before we start! And I would consider the statement to be a good-faith warning or explanation; an attempt on their part to prevent harm, and to find ways to work with me on how to fix this.

    One person’s plan with his doctor is that when he gets shots he’s fully strapped down; absolutely zero movement. He’s too much of a threat to himself and others otherwise. And he’s aware of this, and good-natured about it.

    I’ve had a few of these statements in my career. I’ve had coworkers tell me “If I see a snake I’m running and probably won’t even see you.” So I didn’t send them into areas with potential for snakes. On my part, I always tell people about my lack of sense of smell, because that can put us all at significant risk (I can’t smell toxic vapors that are not uncommon in my line of work). I’m not saying “I’ll put you at risk”, but rather “I can’t tell when we’re at risk, we need to figure some other method out.”

    What makes this not a threat would be if they can control it or not. If it’s involuntary it’s not their fault and they can’t control it; it’s something happening to them that they’re making you aware of. If they can control it, the burden is on them to do so to the extent possible. If they’re doing it intentionally (or want you to believe they are), that’s a threat and is 100% unacceptable.

    I can’t tell from the letter where this falls on that scale. But I think before you can figure out how to handle this you’ll need to now that information. If you react to a warning as if it’s a threat you’ll increase tensions and be perceived as escalating hostilities. If you react to a threat as if it’s a warning you’re putting yourself in danger. Neither are good options.

    1. Rainy*

      I have a weird reaction to drilling in one of my molars–it makes my left leg kick wildly. I had a filling in that tooth need to be redone (it was 20 some years old) and I didn’t remember to warn the dentist until we were mid-filling and the single-limb flailing started. She said “Hold still!” and I was like “Oh, right, I can’t–when you drill on that tooth my leg kicks.”

  53. Dawn*

    That is…. not a minor amount of accrued vacation. Assuming it’s paid out as 8-hour days, which vacation usually is, someone with over 200 hours accrued has at least 25 days of vacation built up.

  54. Yup*

    LW#1: I think a key piece of info is missing here. If this is a male patient threatening a woman hygienist, it takes the inappropriateness to a whole new level and moves into a power dynamic on the sliding scale of gender-specific abuse. This wouldn’t then just be a patient who is afraid and lashing out–it would be a man using violence to get what he wants (or doesn’t want), and that is really highly problematic over and above the advice given here. I would act accordingly in my response.

    1. bamcheeks*

      I could go both ways on this. In general, I agree that there’s a gendered element when a man threatens a woman which aggravates the offence. However, I also know men who work in social care and healthcare roles — particularly non-medical roles but high-contact like nursing. allied health professions like physio, OT, hygienist, phlebotomist– where they are more at risk of violence because patients think it’s “OK” to threaten a man with physical violence. It’s important not to downplay or disregard the risk of violence for male care providers either!

      1. Yup*

        Definitely not. All work violence should be taken seriously. That said, violence threatened by a dominant group against a group with less power needs to be seen via an extra lens and appropriate action taken.

        1. Boof*

          As a healthcare provider I think we can be aware of demographic nuance all we want, but strive to treat all equally. I’m not sure what professional “Extra lens” gender adds to this. The only “Extra lens” is how much LW perceives an actual physical threat vs just a compliance problem (ie, a little kid who can’t actually do any damage unless they manage to hit a needle or something vs someone with significantly greater strength would be interpreted differently). If there’s less physical threat and/or lack of capacity could handle it a bit differently ie offer a squeeze ball or something like some have kindly suggested above for kids or for folks with exaggerated reflexes.

      2. Dinwar*

        A very good point. It’s widely known that violence and abuse against men is drastically under-reported for precisely the reason you say–people think it’s okay to hit men or verbally or emotionally abuse them, because we’re supposed to be tough and we can handle it. We simply don’t know the rates at which these things occur, because of a society-wide suppression of this information. Essentially our entire society has gas-lighted men into believing that they deserve to be abused–and that if they object to it, they deserve more of it. That’s starting to change, but it’s really, really slow.

        Turns out the patriarchy isn’t any better for the vast majority of men than it is for women. Maybe 5% win, and the rest of humanity suffers.

  55. Yes And*

    LW5: Management needs to do two things concurrently.

    1. Adopt a policy that unused vacation time is forfeited after a reasonable period. Phase it in with a grace period so that people who have a lot of vacation accrued can don’t get shafted by the change. That both gets an unreasonable liability off the books and encourages employees to use their vacation (which management should want!).
    2. Examine workloads and coverage/redundancy to make sure people can actually take their vacation without damaging their teams or drowning themselves when they get back.

    LW4: Maybe he was previously an audition coach, and he meant “building repertoire”?

  56. MollyGodiva*

    If they won’t meet with you, they are not “leadership”, they are management. Leadership is earned.

    1. fhqwhgads*

      It sounds like LW met with two levels above but not the third. So the beef is something like “the VP and Senior VP met with me and heard the concern, but the CEO won’t”. Whether that’s reasonable on the part of the CEO or not depends on context we don’t have. It has nothing to do with “earning” leadership. Might be that having met with the other two levels was sufficient and LW is out of place wanting the third. Might be absolutely necessary to meet with the third but the calendar is tricky. Or it’s higher priority for LW than it is the higher up. Or all the other things Alison’s answer covered.

    2. Managing While Female*

      I think this is a bit of a harsh take. It had only been 2 weeks, LW had been heard out (and felt heard) by the two levels above them, and, as Allison pointed out, people higher up in the management chain often have a lot of competing priorities they have to balance. It would be unreasonable for every employee to expect a one-on-one audience with, like, the CEO or someone else high up at a large company every time they had something they wanted to talk about. I think Allison’s advice here is spot-on.

  57. gmg22*

    I’m sorry that happened to the LW and I don’t blame her for feeling unsafe. That said: I don’t think we’re always realistic about what the dentist is and does, and the unfortunate reality that a lot of patients have had really scary experiences in that chair. I have had a LOT of dental work in my life (adult teeth being late to come in, wisdom teeth needing to come out, orthodontics X2, gum graft, you name it) and I’m a pretty solid patient. But I still have a little bit of remembered trauma around a singular incredibly unpleasant experience with the dentist. My dental practice at this time (I was college-aged) did not have a license to administer anesthesia (including nitrous oxide), but despite this they assured my dad that we did not need to seek out an oral surgeon for removal of my lower wisdom teeth, and that it could be done with only novocaine for pain mitigation. Folks, do not ever, ever agree to anything like this — I don’t even think it should be legal. I was so scared in the chair before the appointment began — full-on shaking and hyperventilating — and my longtime dentist and hygienist somehow COMPLETELY failed to notice this. Hence when dentist spun around briskly in the chair, no verbal prep/heads-up for me, with the novocaine needle poised and immediately ready to go into my mouth, I (absolutely involuntarily) shrieked and threw up my hands, almost sticking myself with the needle. The dentist yelled “JESUS!!!” and let me know he was furious with me (the hygienist also scolded me that “I could have seriously hurt myself,” as if that wasn’t what they were essentially about to do to me anyway), to the point that when we resumed the procedure — which clearly should not have happened at that point — I felt like he was physically taking out his frustration on me. Though I fully understand from a clinical perspective that the lower wisdom teeth need to be broken into pieces for removal, it was hard after that incident to escape the feeling that he was really just whaling on my mouth out of anger. This was 30 years ago and I still remember it vividly and in ugly detail. I was an adult, but a young adult — they simply needed to have done better than that for me. It is very possible that the patient previously experienced something like this, but is unfortunately just verbalizing their resulting fear really poorly and in a way that understandably made the LW feel unsafe. The answer for LW is simply to have an honest and empathetic discussion with this patient before the next appointment, inviting them to explain the root of their fear of/at the dentist, and then firmly setting the boundary of how it is vs isn’t OK to express that fear.

    1. Boof*

      :( that’s aweful I’m sorry to hear it.
      I’m pretty sure I had my wisdoms out with local anesthetic only, but I wasn’t terrified; I’m weird like that. (and i do say weird; I think i was always unusually calm about shots as a kid, I took it as a badge of pride as a teen, when I had this done, to be tough (i’ve learned!)
      As a doc who does chemo, who did a lot of bone marrow biopsies, it’s all about meeting people where they are and minimizing distress! Someone’ who’s jumping when i’m just touching their hips to get the landmark, or throwing up just entering the clinic, needs a lot more TLC and yes, sedation etc, than someone who’s clearly on the opposite end of the spectrum and that sucks your dentist blamed you instead of just dealing with the situation appropriately and referring you to someone who could give you anesthesia!
      Some people need ativan, or even full blown anesthesia for MRIs, some do not! Uhg. Again, I’m horrified your dentist got mad at you for being obviously scared.

  58. I should really pick a name*

    it could be done with only novocaine for pain mitigation. Folks, do not ever, ever agree to anything like this — I don’t even think it should be legal.

    I’m really sorry you went through that experience, and clearly this was the wrong approach for you. They should have consulted you/your parents about your experience with needles at the very least, and prepared you properly.

    But novocaine for wisdom tooth removal is a reasonable approach for some people (having experienced it myself).

    1. gmg22*

      No, I had plenty of experience with needles — that really wasn’t the issue (and it was unfortunately also why they didn’t expect me to freak out at the needle this time). I was scared of what they were going to have to do PHYSICALLY to me to get the teeth out, not least because multiple people had unfortunately regaled me with horror stories of their own procedures coupled with shock and amazement that I was going to have this done without being put under or at least having nitrous oxide. As a dental provider, you simply can’t assume that even the best patient will be that way every time, and you have to pay attention to cues of fear in a patient and not ignore them because you’re in a hurry or whatever. And I have never met anyone else (besides now you, virtually) who had their wisdom teeth, especially the more-difficult-to-remove lower ones, out with only novocaine and no additional sedative or pain relief.

  59. Immortal for a limited time*

    #5 – Early in my career I worked for a daily newspaper in the U.S. They had rules about spreading planned absences across the whole year, because obviously the paper couldn’t be published around the holidays if everyone were allowed to save up their vacation days to use at the end of the year. My spouse retired from a not-for-profit organization tied to the public school system that offered extremely generous benefits, including time off, but they also enforced mandatory usage policies for the reasons Alison mentioned. People who retired or left would usually do so at the end of the school year/fiscal year, and several large payouts of unused vacation days could have bankrupted the organization.

    1. RussianInTexas*

      My previous job was pretty generous with PTOs, especially by the US standards. And you had access to all your days on the day one of the new fiscal year. But none of the PTO rolled over. As in 0. Use it or lose it.
      They also had a policy that you had to use half of your vacation time by the middle of the year, unless you had a longer trip planned and had a manager’s dispensation, and they would remind you until you do take time off.

  60. CZ*

    Its weird that having to use some accrued PTO is seen as “sticking it to you.” In many companies, like my current one, you can’t carry over more than 40 hours. Having 100 sitting there is ridiculous and someone needs to take a break once in a while.

    1. Rainy*

      Yeah, I’m super confused as to why I would be resentful at being told to take paid time off. I earned that vacation and I need a break! Of course I’m going to use it. :)

    2. I should really pick a name*

      I don’t think there’s anything wrong with what they company is doing, but having 100 hours of vacation time stocked up isn’t ridiculous either. That can simply be a case of planning a 2 week vacation in the second half of the year.

    3. Dinwar*

      It’s not unusual for people in my company to have 100+ hours of PTO built up. I generally like to keep at least 80, and I’m more comfortable with 120+.

      The reason is that our work is feast-and-famine. Sometimes we’re working 60+ hours a week, and sometimes we’re struggling to find 20 hours of work. But we’re still expected to have a minimum of 40 hours per week. So we accrue the PTO during busy times and spend it during the slow times. If you’re smart about it, and plan ahead, this actually works out in your favor. You can take a nice long break (120 hours is three weeks) without worrying about work because there’s literally no work to worry about! Then you get back ready to hit the ground running when work picks up. Plus, if you always have two weeks of PTO in the bank you don’t need to worry as much about minor downturns in workload. It acts as a safety net in case a project gets delayed by a week–it’s much easier on your mental health to say “Oh, it got pushed and that was my only work? Well, guess I’ll head to the beach!” than it is to say “Wait, that was my only work; now what do I do?!?!”

  61. NobodyHasTimeForThis*

    #5 is so much better than the option my spouse’s company is doing. For the last 3 quarters, EVERYONE has to take 3 days each quarter. It does not matter if you have the time accrued or not. If you do not, your balance goes negative.

    So far this has been 9 days before summer starts for many people who only get 10 days a year and now have no vacation to take for summer when their kids are off school.

    This is not a shutdown/furlough situation – they have those from time to time where the building closes for a week and everyone has to take PTO or unpaid. This is strictly a take vacation off the books move but they are applying it stupidly. Tiered makes a lot of sense

  62. MBG*

    Interesting timing. Just this morning we refused to schedule a patient who was making violent threats to staff (on the phone) and while we were calling the referring provider to explain why, the patient walked into their office and hit/punched a staff member.
    My words would be “I understand you are scared. I really do. But if there is any chance that you are going to hit me, this appointment is over for today. I’ll give you a few minutes to decide how you want to proceed.”

  63. SusieQQ*

    LW1 — just wanted to say I’m so sorry you had to go through that, and as someone with terrible dental anxiety I so appreciate the gentle, patient ones who can help me work through my fears. I often white-knuckle through my dentist appointments, and have cried a few times in the office (how embarrassing). I have requested not to be seen by certain people who I thought were too rough with me. At a root canal I was about to get out of my chair and walk out the door when a kind and gentle dentist convinced me to stay.

    But it never ever occurred to me to hit, or threaten to hit, anyone. I get dental anxiety, I truly do, but it’s not okay.

  64. Urban Chic*

    LW #3 – With respect, I do not think it is realistic for top leadership to meet with you on these matters. Organizational change takes time, and if, after feeling heard by your boss and their boss, you still are unsatisfied with change or organizational prospects, I would exit and look for a new job.

  65. Observer*

    #2 – Job seeking coworker.

    I’m on record as believing that the whole concept of “tattle tale” and “snitch” doesn’t really have a place in the office. But there are exceptions. And your letter is one of them.

    Now, I’m going to assume that you were in some way affected by your coworker’s lack of skills, so bringing that to your manager is fine. But what is you excuse for running to management with the guess that your coworker is seeking another job? (And yes, it’s a guess because despite the way the call started, you don’t actually know what is going on.)

    1. OP2*

      100% agree and that’s part of why I didn’t end up saying anything – and the comments here confirm my decision.

  66. Sneaky Squirrel*

    LW3 – Since you’re a director, you likely know already that top leaders have to delegate responsibility downwards. If they didn’t, their whole day would be consumed by employee concerns and chances are they’re not oblivious to the employee grievances already. Whether or not the top leaders make time for yours may depend on the nature of the concern and the business impact. Are you coming in with personal grievances and not liking the answers you’re getting in from the two tiers of leadership above you or are you attempting to present a business proposal on behalf of your role as a director?

  67. so very tired*

    Re #1: it’s never ok to threaten or put your hands on another person unless they’re an immediate danger. Just wanted to make that 100% clear because I know some people won’t read properly.

    I have MASSIVE dental trauma + ADHD and autism. My sensory issues are very difficult for me to deal with on a good day, and on top of being at the dentist? It’s a miracle I can even go. The bright lights feel like they’re beaming directly into my eyeballs, the vibration of the tools, the loud whirring of the tools, the metal objects poking my mouth, it’s all unbearable. I’m already at 100 in terms of not being able to deal with it. And sadly, most dental professionals I’ve been to seem completely clueless as to how to help people like me who have a terrible time with it all.

    I have no way of knowing if OP is one of these dental professionals. Making someone comfortable for a procedure has varying levels – what works for one person may not work for another. I am writing all this TL;DR to plead with any dental professional reading to please understand this and try to do better. If you’re already doing better, great! You’re the example we need. If not, go back and read the rest of this comment.

    I’ve had reactions at the dentist that probably scared the ish out of people in the office: screaming from pain, swearing very loudly because I hit my sensory limit, and one time I just straight up walked out with the spit cloth thingy around my neck still because I was tired of the hygenist shaming me for not being able to take care of my teeth because my mouth hurts all the GD time and I can’t see a dentist without melting down.

    Treat patients with compassion. It’s hard being in the chair.

    1. Caz*

      I appreciate you may have already tried this, but would ear plugs help with the noise aspect? Or would they only aggravate the vibration? I also have issues around the dentist (greater than the average person, not as great as yours and you have my sympathy for that) and finding a REALLY GOOD practice who are happy to work with me at my pace has made a world of difference.

      1. so very tired*

        Unfortunately headphones don’t help because noise cancellation technology doesn’t block all noises. I hope that one day we’ll get there.

        Headphones or not, the vibration of the tools is still a problem and I don’t know how to solve that aside from being knocked out completely every time I go to the dentist.

  68. Caz*

    OP1 – I am more than the average level of anxious about visiting the dentist. (I hope I have never said anything that could be interpreted as a threat!) In the last year I have been going to a new dental practice and the dentist and hygienist have been very kind and patient with me and its helped allay a lot of my anxiety. I wonder if you could approach this patient – after making it clear what kind of behaviour and language is and is not acceptable, of course – with a message that, if he is uncomfortable or needs to stop, all he needs to do is raise his hand? This is the agreed signal my practice and I use and knowing I have that level of control over the situation makes it easier to tolerate for me. Best of luck!

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