Counselor’s corner: The good, the bad, the rude-managing difficult patients

Have some of your patients been hitting the “jerk workshop”? These kind of behaviors can mask dental anxieties. Here’s how to defuse the situation.

Kandice Swarthout, MS, RDH, LPC

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Editor’s note: Counselor’s Corner is a recurring column by Kandice Swarthout in the RDH evillage e-newsletter. Subscribe here.


An acquaintance of mine owns a kettlebell gym. On the occasional Saturday morning, he conducts a “jerk workshop.” If you know your way around the gym, you know that a jerk is a power move that thrusts the kettle bell or the barbell over one’s head. Every time I see his promotional post on social media, I giggle to myself and suddenly see the face of my jerkiest patient. I imagine that my patient must have been in the front row, pen in hand, at every jerk workshop. After all, it seems to take practice to act as nonsensical as this patient.

Come on, you know who I am talking about! The guy in the suit that snaps your head off because he is too important to get off his phone to do health history. The lady that treats you like dirt, but it oh so excited to see the doctor. She will not turn her head towards you and rolls her eyes, but suddenly she is Mary Poppins for your doctor. Interesting dichotomy.  Whether you are a new graduate or a seasoned hygienist, I am willing to bet my shoe collection that you have had this experience in one form or another. What is this behavior about anyway? They made the appointment with me. No one has forced them to come sit in my chair and yet, here they are. Consensual, yet irritated, rude, and arrogant.  At first chat, my feelings are hurt. I wish things upon them like rampant decay and a flat tire on their way back to their very important job. As a young hygienist, I took these things very personally. I thought perhaps it was me. Maybe I was putting across energy that they did not like, or I came across in a way that did not seem polished and professional. As I grew more in my practice, I started using the tactic of kill them with kindness. This strategy actually works some of the time. Appointment after appointment, I did not let them see me sweat and I returned their rapid fire with “Sweet as pie” responses.

Today, as a licensed counselor, educator, and a longtime clinical hygienist I see it in a different light. I have come to realize that most of the time these patients are suffering from some form of anxiety. Their unbecoming behavior stems from the fear of the anxiety being revealed. It is a defense mechanism. I have the choice in handling this several ways. Sometimes a patient cannot be swayed, and I bail out of the tireless efforts to please them, leaving the patient to sulk as we both sit in silence. Other times, patients can be calmed with defusing tactics. My more current tactics involve reflection back to the patient. Sometimes it takes gentle­­––but straight forward––confrontation to defuse the attitude or pending conflict.

You might be thinking, “Kandice, I don’t really care about defusing conflict at this moment. I really just want to stab him between 18 and 19 with my explorer.” Rightly so. I understand this frustration. I believe that these exhausting and futile interactions with impossible patients are one of the many contributors to clinical burnout. When we have the confidence to take control of the situation and own our responsibility in the interaction, we can reduce that feeling of fatigue. A key component to moving forward in a more positive environment with this patient is using empathy. The patient may then choose to join you and enlighten you on what sets them into this tailspin of jerkitis.

Empathy is the act of joining another person by attempting to understand their position. It involves setting aside biases or defensiveness and putting yourself in the other person’s place. This can be quite difficult in this situation because we are limited on time, have a long list of assessments and treatments ahead, and frankly, did not get in this profession to be disrespected. Empathy creates connection and connection “helps to build trust, demonstrates respect, and forms a space for the kinds of conversations that can lead to the resolution of issues.”1

When we use empathy as a conflict deflector, the “fight or flight” response is deferred, and we can engage in more personal and vulnerable interactions. An empathetic stance, versus a defensive reaction, can create an environment that is more conducive for patient care. Next time you encounter the patient that sat front and center at the jerk workshop––taking copious notes––remember the power of empathy. Consider your patient’s position and that perhaps they are masking a high level of anxiety. Before you bail out in frustration, make an effort to empathize and connect.


1. Gerardi D. Conflict engagement: Creating connection and cultivating curiosity. Am J Nurs. 2015;115(9):60-65. doi:10.1097/01.NAJ.0000471251.58766.39


Kandice Swarthout, MS, RDH, LPC, is a 1997 graduate of Texas Woman’s University Dental Hygiene program and a 2013 graduate with a Master of Science in Counseling and Development from Texas Woman’s University. She is a full-time faculty member at Collin College, where she teaches community dental health and research. Kandice is a licensed professional counselor and has worked in a private practice and local jails as a mental health counselor, focusing on trauma and crisis intervention.

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