Tips For Working with Difficult Patients

Dimensions Brand Ambassador Veronica Bonta, RDH, BS, offers dental hygiene students some insight on how to best manage difficult patients in your dental chair. 

“You can’t please everyone,” my boss said. He just delivered the news that a patient called him to complain about me. He is a very understanding dentist who, despite having just gotten an earful from one of our difficult-to-please patients, can empathize with how challenging our jobs can be. He went on to tell me that my asking the patient why she could not recline further in the chair and my explaining why I needed her to recline further did not sit well with her. She took my line of questioning and my desire for compromise to be offensive and inappropriate, but from my perspective, I was just trying to provide the best service to her and save my back at the same time. 

This is just one example of the many difficult patients I have encountered in my career. The truth is that not every day goes smoothly and there will be more challenges to come. Working with the public is never easy and we, as dental hygienists, are literally working closely with people. There is absolutely no way to control who sits in your chair or what his or her disposition may be; however, you can control how you react. I hope to offer some insight on some of the more common “difficult” patients and a few tips on how to respond.

I DON’T NEED X-RAYS

This scenario will repeat itself time and time again. You have informed your patient that he or she is due to have bitewings and an exam with the prophy, and he or she shoots you down with “I don’t take X-rays” or “I don’t want to see the doctor.”  What do you do? Your practice has a protocol that you’re trying to follow, but you can’t exactly force a Rinn holder in the patient’s mouth. Even after you have explained why X-rays or an exam with the dentist is important, he or she still do not budge. 

At this point, it is best to consult with the dentist on how to proceed. The dentist will either advise you on your next steps or will take a minute to speak with the patient. The dentist may convince the patient to take the X-rays or they may come to a compromise, but ultimately it is the doctor’s call on how to work with this situation. 

DON’T LAY ME BACK TOO FAR

There are several legitimate reasons why patients cannot recline fully: neck or back issues, severe vertigo, or recovering from back or neck surgery, to name a few. It is completely necessary to respect their medical condition and do your best to accommodate them. However, there are patients who simply do not want to recline all the way. I have been told by some that they “just don’t feel comfortable” or that “I feel like I’m upside down.”

The important thing to remember is that they are in that position for 45-60 minutes, but you have to do your job all day, all week. My advice is to communicate that their being in a supine position is the best way for you do get your work done safely and timely. Offer a small compromise of raising their head an inch or so. They may not be completely content with this arrangement, but at least they will understand why it’s necessary. 

THE VERY IMPORTANT PATIENT(VIP)

Every practice has their VIPs: patients who arrive late, talk on their phones, and get annoyed when they are asked to update forms. They are always in a rush and appear inconvenienced to be at the office. They are short with communication, hard to form relationships with, and can be just plain rude at times.

I think it’s best to go with the flow with these patients. Take a deep breath and realize it’s not personal. Consider it a win that they show up for their appointments, provide your best services, and just know it’s OK if you never build rapport with them, they strictly want to get in and get out. 

OTHER COMMON SCENARIOS

• The noncompliant with self-care patients. The patients you’ve worked super hard with on periodontal treatment and oral health instruction to save their teeth and gums, but they will not pick up a toothbrush or floss at home. 
• The “don’t lecture me” patients. No matter what approach you take to offer self-care tips, you are “lecturing” them and it’s not welcomed. 

With patients like these, it’s easy to feel disappointed or defeated. But it is important to keep at it. Sometimes it clicks for the patient later. Just stayed focused on providing oral hygiene guidance and your best service and don’t forget to document all of your recommendations. 

DON’T BE DISCOURAGED

In the words of my incredibly wise boss, you really can’t please everyone. There will always be that one patient who is unamenable, and you just can’t take it personally. Cherish the great patients who you love and rally through your time with the ones you don’t. Take solace in knowing that most patients are really very kind and happy to have you as their hygienist.