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How dental hygienists can work with "difficult" patients

Sept. 9, 2022
While a common approach to difficult patient encounters may be to “power through,” it does little to improve relations—or patients' oral health. Julie Whiteley offers some commonsense tips for breaking down walls and building rapport.

Editor's note: Originally posted in 2018 and updated regularly

Some patients are easy for us to connect with. The relationship is easy and flows naturally. You know and understand them beyond their oral health. They often have similar values about dentistry and are your biggest fans. When you see their name on your schedule, it makes your day.

But what about the other patients? Those names that cause you to tense up in anticipation for a visit that will more than likely feel less than enjoyable for you both. Those relationships seem anything but natural and easy. Your attempt to educate, inform, and provide the best quality of care is met with objections, discomfort, and resistance.

A common approach to these types of encounters may be to “power though” by offering little in the way of dialogue. You may try to usher them out the door as efficiently and quickly as possible and hope you don’t see them next time. Another approach may be to counter with a goal to “make” the person see your side of things; you hold the education and license. In my experience, neither of these is effective at fostering a relationship with the patient. The result is frustration and stress along with a patient receiving less than the standard of care, as they seemingly dictate the appointment which can also raise questions about liability.

Also by Julie Whiteley:

5 things I love about you, dental hygiene

4 things you can do now for better communication

As health-care providers, we have the responsibility to try to relate to and help the patients entrusted to our care, regardless of whether it’s easy or not. The “bad behavior” we see in dentistry can at times be attributed to unspoken fear. The fear can be from bad past experiences, anxiety about pain (real or anticipated), fears about costs, and the list goes on.

The concept of relationship-centered dentistry is a vast one. Tn short, it involves patient-provider communication skills that result in more involved patients with better outcomes.

Here are some tips to help you as you encounter patient challenges.

Approach with confidence

For example, perhaps your patient is angry that you aren’t their regular provider. Our first inclination may be to retreat or to become defensive. Stay calm and confident, keeping your emotions in check: “I understand. I apologize that it wasn’t made clear to you that Jill wasn’t going to be here today. I’ve read all of her notes and can assure you that I will take good care of you. We can also make sure that we set your subsequent appointments up with her.” Your professional tone and confidence, coupled with understanding and a solution, can go a long way. Often, these encounters end up being the patients who become your biggest supporters.

Show true curiosity

What is it about the treatment or the visit that is a concern to them? Instead of talking about the standard of care to patients who refuse x-rays—probably not their greatest concern—take it from what does interest them, themselves and their opinions! You may be surprised by the answer.

I recently had a patient that felt she didn’t need x-rays because her teeth were crowned. I told her that I understood how she could think that. I also shared with her that dental disease often comes without pain or symptoms. If we wait for pain to be our guide, we are almost always looking at more aggressive and costly treatment. She appreciated the dialogue and agreed she wanted the x-rays and took to the idea of “protecting her investment.” When we understand more about the patient’s beliefs, values, constraints, and dental IQ, it puts us in a better position to help guide them toward the right care.


When we approach with curiosity, it is equally important to listen. In the words of Stephen Covey, “Most people do not listen with the intent to understand; they listen with the intent to reply.” Take the time to hear and understand what the patient is saying. Patients who feel heard are more likely to listen to you.

Drop the need to be right

We know what we know and are passionate about it. The more we push our point instead of trying to have a conversation with the patient, the more it comes across as lecturing. Think about your response when it feels as if someone is talking at you versus to you? The common reaction is to either stop listening or respond with an opposing opinion. When we approach with curiosity and listening, this piece falls more easily in to place and you stand a better chance of helping the patient break through a barrier to care.

Avoid judgment

Some patients will have different beliefs and values. Everyone has a story and we earn the right to hear it. By being open and empathetic (standing in their shoes), we stand a far greater chance of bridging the gap and making a difference for that patient.

Maintain boundaries

We need to be mindful that not every patient is ready for this type of dialogue. We need to know when to step back. Further, we need to respect our own boundaries. When a patient’s behavior is aggressive or inappropriate, we need to have the confidence to address and escalate. Additionally, when continued refusals are compromising the basic standards of care, it is equally important to escalate within your office.

These conversations take practice and patience. Change won’t always happen in one visit, but when you are able to bridge that gap with a patient, it is worth the effort. To know that you have made a real difference in the way someone perceives dental care is a wonderful feeling! Those patients that you once dreaded can actually become those who you look so forward to connecting with. They can make your day!