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Teaching home care instructions to rude patients

Jan. 8, 2020
When patients are so rude it leaves you speechless, what do you do? Here's how to handle it, straight from the wisdom of Dianne Glasscoe Watterson.

Dear Dianne,

A patient recently made a very insulting remark to me when I was attempting to teach him how to brush his teeth. He said, “Young lady, I’ll have you know I’m 78 years old, and the last thing I need today is you telling me that I don’t know how to brush my teeth!” I can’t remember any patient ever speaking to me like that, and I was caught totally off guard. I was speechless! To make things worse, when the doctor came in to do the exam, the patient told him that he did not appreciate “the insinuation that I do not know how to brush my own damn teeth.” In the future, he would prefer if I worked in silence. I think my doctor was just as surprised as I was. But he said, “Carrie was just doing her job, and if you were doing yours well, she wouldn’t have anything to discuss, right?” The patient just grunted and crossed his arms over his chest. It was very awkward, and now I’m nervous about having to see this patient again. Later that day, the doctor told me to just shrug it off and try not to take it personally. I’m the only hygienist here, so can you give me any advice on how to handle this rude patient in the future?

Carrie, RDH

Dear Carrie,

Your question brought to mind an incident I experienced with a particularly rude patient. He was a big burly truck driver with poor home care and high caries incidence. I escorted him to my operatory, and as he sat down in my chair, he said, “I don’t need no lecture today!” Whoa, what a way to begin an appointment! I don’t think I even answered him, but I remember thinking how much he must have been dreading his visit. Evidently, he had been “lectured” repeatedly about his poor home care. He was one of those people who looked like he had brushed his teeth with a donut. I had to dig through the crud to even find his teeth. People like this used to make me feel downright indignant, and I fought the urge to say, “Why are you even here? You’re wasting my time and your money!” I never actually said it, but the idea crossed my mind. 

As dental hygienists, we take the task of teaching proper home care very seriously. After all, we are preventive specialists. It is branded into our psyche in hygiene school that it is our sworn duty to drag our patients—sometimes kicking and screaming—to some preconceived level of hygiene mastery. If our patients are unable to achieve that level of mastery, there’s only one conclusion: I’m a failure. We somehow feel responsible for our patients’ lack of motivation or willingness to do even simple home care tasks. Every hygienist has patients who have atrocious oral hygiene, and nothing ever changes, no matter how passionately we admonish patients through whatever means available. These are the patients who cause you to get a bad case of indigestion when you see their names on your schedule. 

After 47 years in dentistry, I have some advice for all those hygienists who fret over such patients. Here it is. Are you ready? Get over yourself! That’s right, just get over yourself. Accept the fact that “not very good” is the best some patients are ever going to do with their home care, and you can only treat patients within the boundaries that they have set. Instead of causing people to dread their visits with you, learn how you can connect with these patients on a different level. Your patients with terrible oral hygiene are needy. They really need your services, but if you fuss and make a big deal about their oral hygiene every time they come in, they will dread seeing you. 

Here’s another one of my examples. Fred was a senior citizen with a sweet disposition and the worst oral hygiene I’d ever seen. After several episodes of oral hygiene instructions and no change, I came to the conclusion that it would be best if I could be his friend and accept him as is. He loved to talk about his deceased wife and his grandchildren, and they were often our discussion topics. One day I said, “You know, I believe your gums would be happier if they saw me a little more often, say, every four months instead of six. What do you think?” He said, “Whatever you think is fine with me.” His agreement to come in more often happened only because he liked me. 

When your patients like you, they’re more amenable to your treatment recommendations. (However, it doesn’t guarantee that they’ll brush any better.) When they like you, they’re less likely to miss appointments. When they like you, they’re less likely to sue you. 

I’d venture a guess that your rude patient is affluent and bristles at any suggestion that there is any room for improvement with anything he does. I base this on my experience working for a short time in a “country club” practice. Many of the patients I saw were hurried, demanding, and unreceptive to home care instructions. It was the most difficult patient population I’d ever experienced. 

I’m encouraged that your boss defended you. I also agree that you should not overthink this man’s behavior or lose any sleep about future appointments with him. After all, you did nothing wrong. He was the one with the bad attitude. Just make sure his remarks are duly recorded in the patient narrative in his chart. I advise you to put quotation marks around his exact words. This may be helpful to others who see this man in the future. 

As to how to handle him in the future, here’s what you do—kill him with kindness. Be the best hygienist he’s ever seen, and even skip the home care lessons. What you’ve learned from this experience is that not all patients will appreciate your efforts to help them. That’s just the way it is, so roll with it and don’t take it personally. 

In 1961, there was a song released by the Shirelles titled “Mama Said (there’d be days like this)”. Think of that song and realize, you just had one of those days. 

I think I’ll write a song and title it, “I don’t need no lecture today” and dedicate it to all of my dental hygiene sisters and brothers. It’s a catchy title and it might even make a good rap song. Keep your eye on the top 10 charts! 

All the best,


DIANNE GLASSCOE WATTERSON, MBA, RDH, is an award-winning author, speaker, and consultant. She has published hundreds of articles, numerous textbook chapters, and three books. Her new DVD on instrument sharpening is now available on her website at wattersonspeaks.com under the products tab. Visit her website for information about upcoming speaking engagements. She may be contacted at (336) 472-3515 or by email at [email protected].