The Troublemakers: How to Deal with Difficult Patients

by Jordan Stone

Eventually, every dental hygienist will deal with a difficult patient. Despite best efforts, a patient may be angry or upset with the care they have received or something that has been said to them. Sometimes they will be angry for no perceivable reason at all. Regardless of why the patient is being difficult, dental hygienists should ensure that they know how to respond. While an appropriate response may defuse a situation involving a difficult patient entirely, a response interpreted as insensitive, improper or unprofessional may lead to a professional complaint or worse. Here are six tips for dealing with those tricky patients.

1. Watch your body language
Ensure that your body language does not exacerbate the situation. Even if you are saying all the right things, your body language can send the wrong message. For instance, research has shown that crossing your arms gives the impression of being defensive and closed off, while standing with uncrossed legs or arms gives off an impression that you are open and available. Sitting down when speaking to a patient can indicate that you are taking the time to listen to the patient. Additionally, nodding can give the impression that you are listening and agreeing with what the patient is saying to you. Facial expressions are also important. If a patient thinks you are smirking, rolling your eyes or furrowing your brow, they may believe you are discounting their concerns.

If the patient believes you are listening and open to their concerns, they will be more receptive and open to your messaging, and it is more likely the situation will be defused. Some research has shown that people’s perception of others is more influenced by body language and voice tone than it is by word choice. When you are dealing face-to-face with a difficult patient, it is important to be mindful of your body language.

2. Address the patient’s concerns head-on
When a patient is upset or angry, it is important to identify what the problem is. It is natural to become defensive when a patient is being difficult or accusing your clinic (or you!) of acting improperly, but it is critically important to avoid that instinct. Do not initiate the conversation with a defensive statement. If a patient is being difficult, immediately ask them what their concern is. This serves two primary functions. First, it allows you to understand why the patient is upset so that you can identify solutions to resolve the conflict. This gives you the information you need to solve the problem. Second, it shows the patient that you are listening to their concerns, which helps minimize and de-escalate conflict.

After the patient has explained their concerns, you may need to gather additional information before you can respond. That’s okay. If you cannot respond immediately, advise the patient that you will look into the issue. Provide a timeline and stick to it. Once you have gathered the information necessary to respond, approach the patient and explain what actions you are taking in response to the patient’s concerns. If you believe the patient’s concerns lack merit, it is important to be tactful and respectful in your response. While you may ultimately tell the patient that you believe the clinic acted appropriately, make it clear that you are committed to the patient and that you will keep their concerns in mind going forward.

3. Keep calm and carry on
It is always important to keep calm and measured. The worst thing you can do is get angry and start a shouting match or engage in a heated email exchange. This will only add fuel to the flames. Avoid raising your voice or talking over the patient. Ensure that the tone of your communications is polite and respectful. Keeping calm is one of the best ways to keep the situation from escalating (and this often takes great self control).

That being said, if a patient is being abusive, you and your staff should not tolerate such behaviour. If there comes a time when you need to ask an abusive patient to leave, be respectful and measured while doing so, but do not be afraid to take the steps that are necessary to protect yourself and your colleagues.

4. Consult colleagues
Not every dental hygienist has decades of experience. If you have never dealt with a difficult patient before, consider consulting with more experienced colleagues, including dentists, dental hygienists or administrative staff, within or outside your office, who may be able to provide advice on how to manage the situation. If you are unable to deal with the situation yourself, a more experienced colleague may be able to step in and help bridge the conversation with the patient.

If you have not previously treated the patient, consider consulting with other colleagues who have treated or dealt with the patient. If the patient has never complained before, this may be a sign that there is a genuine issue of concern. By contrast, if the patient is always difficult or frequently complains, this may guide your expectations of how the patient will respond to your comments or suggestions. Your colleagues may also have recommendations for what has worked in the past with this particular patient. In a perfect world, concerns regarding the patient will have been noted in the patient record, allowing you to prepare yourself and plan accordingly, perhaps avoiding a difficult situation altogether.

5. Document your interactions
It is important that you carefully document your interactions with a difficult patient. A great deal of complaints against dental hygienists and other professionals come from angry or upset patients, regardless of whether there is any merit to their complaint. If you receive a complaint against you from your regulator, your records are often your best defense – the adage “If it’s not written down, it didn’t happen” is often true when dealing with an investigation by your regulator.

Record as much as possible about the interaction with the patient, including the time, date, method of communication, nature of the conversation/interaction, concerns expressed by the patient and steps taken by the clinic to address the patient’s concerns. Similar documentation should be kept by administrative staff who are typically the first line of contact with patients.

While thorough documentation will not avoid a complaint, it can increase your odds of having the complaint against you dismissed. Documentation also helps your colleagues in the office know in advance of a potentially difficult patient, enabling them to take the necessary steps to ensure that the can manage the patient. Further, where a patient is continually difficult and ultimately acts inappropriately, records of previous interactions can provide the information necessary for the clinic to make the potentially difficult decision to cease treating the patient.

6. Follow up
A final way to potentially mitigate the impacts of a negative patient interaction is to follow up afterwards to address the conflict. Following up shows that you are committed to the patient and to resolving their concerns. It also allows cooler heads to prevail. Sometimes people just need some time to calm down. With some time to cool off, the patient may approach you with a more measured disposition.

Within 24 hours of the difficult patient interaction, consider calling the patient or sending an email. Even if you do not have any tangible action to suggest, simply stating that you are available to speak if the patient would like to discuss further can be of benefit. Following up shows that you are engaged in a dialogue with the patient and that you are interested in their thoughts and opinions. If you do not hear back from the patient, that is OK – at least you will have extended the opportunity to the patient and cannot be accused later of not following up with the patient regarding their concerns.

Every disagreement between a dental hygienist and a patient is different. Sometimes, the issue is minor and is exacerbated by simple misunderstandings that get blown out of proportion because of a communication breakdown. In other cases, there is a more significant issue that needs to be addressed. Because there are so many potential reasons why a patient may initiate conflict, there is no single response that is appropriate. However, by being mindful of some basic interaction techniques, dental hygienists can manage difficult patients and prevent minor disagreements from becoming major problems.

While no one likes dealing with a difficult patient, if you take the right approach, you can help defuse the situation and protect yourself and your clinic. Remember to watch your body language, identify the patient’s concerns, keep calm, consult colleagues, document your interactions and follow up with the patient. If you manage a difficult patient interaction well, you may be able to turn an upset patient into a repeat patient.

About the Author

Jordan Stone is a lawyer at GlickLaw, a boutique law firm focusing on health law and professional regulation. Jordan advises and acts for dental hygienists, dentists and other regulated professionals on regulatory matters, such as registration, discipline, and complaints and investigations. He can be reached at and 647-335-7477.

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