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How to Work with Patients You Want to Punch in the Face by Jen Butler, MEd, CPC, BCC

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Your Gripe: You don’t like to work with patients who don’t pay bills. You tell your front desk not to schedule patients who are shopping around. Patients with poor attitudes stress you out completely and when someone doubts or corrects your recommended treatment, you totally lose faith in what you do.

Reality: The more you limit your patient base solely on who you like, who doesn’t stress you out and who doesn’t push you to the brink of quitting, the harder it is to fill the schedule. Each patient presents a unique opportunity for you to navigate through the patient experience differently so that you can connect with them and meet their needs. The reality is that the more adaptable you are with patient types, the more you will be accepting of their unique needs, the broader the patient base will grow, the fuller the schedule, the less stressed out you will feel and the more you will like what you do.

The Solution: Here are some common patient types that illicit an emotional reaction from ortho teams. Sometimes the reaction is anger or frustration. Sometimes it’s resentment or guilt. And sometimes the emotional reaction is lethargy, where you feel stuck in having to treat patients who make your life miserable. Read on to find those patients you can be adaptable with, open your patient base, reduce your stress, and get yourself away from the brink of wanting to punch patients in the face.

The Doubting Thomas and Debbie

Punch: You display all of your hard-earned diplomas on the wall. You earned the right to wear the highly distinguished white coat. You took the Hippocratic Oath. You have a high standard for patient care and you continue to expand your clinical skills by investing thousands of dollars into continuing education. So when you educate your patient on the why and what of recommended treatment and they look at you and say, “I don’t think that’s right,” it’s no wonder you lose your mind.

Reality: There are varying degrees of surprising news and just as many degrees of shock. When patients do every thing they can to take care of their teeth and they still need treatment, it’s shocking. It’s similar to you taking care of yourself by eating well, working out, getting sleep and then going to your medical doctor for a check up and they tell you your cholesterol is high. “What? That can’t be right. I take care of myself.” Patients who doubt your clinical findings are not necessarily saying they doubt you or your skills. Just like with other patient types, it’s not about you.

Solution: When a Doubting Thomas/Debbie reacts to his or her situation, take these steps to work through it:
  1. Don’t come from ego. It’s not about you.
  2. Acknowledge and validate. Say, “Doubting Thomas/ Debbie, you seem surprised by what I found. It’s normal to be shocked by what I’m telling you.”
  3. Ask what they need. “How can I help you understand this better?”
  4. Offer proof. To patients, X-rays are the literal 50 Shades of Gray. They are not the most effective way to show evidence of your clinical findings. Use intra-oral photos, mirrors and the patient’s own sensitivity to gain the acceptance you are both looking for.

The Entitled

Punch: They want discounts and freebies because of their age, title or position in the community. They expect to be treated differently than “regular people” and look at you as their concierge doctor, constantly crossing boundaries with unrealistic expectations.

Reality: No one is born with entitlement issues. This mentality is created, nurtured and reinforced by parents, society, media forums and yearly salaries. The Entitled are a product of several characteristics that we, as a collective group, bring on ourselves.

Solution: There are a few important things to working with The Entitled. First, feel comfortable in your own skin. This is your practice and you have the final say. There’s no reason to have an emotional reaction over someone who literally doesn’t understand that. Second, have clear and written policies and procedures that apply to every patient. The moment you give in to one, the word will spread and more of The Entitled will show up. Third, when you sense someone is feeling entitled and wants something for nothing, smile and simple say no. If you don’t draw the line, they will and you might not like where that line ends up.

The Scrooge

Punch: Money is always a problem with The Scrooge patient. They want to haggle and barter the cost of their treatment plan while simultaneously complaining about any balance left on their bill. These patients seem to lack appreciation for the work, time and money you have put in to get where you are today. If they did appreciate it, they would just say thank you, lay back and open their mouth.

Reality: No one likes to spend money on things they can’t see, don’t get entertained by, or don’t receive any enjoyment out of doing. We all have these types of expenses—from paying penalty fees, to buying car tires or fixing a roof on a house. These expenses are not something people budget for so when they come up they react to them. Recognize the money isn’t about you nor a reflection of your work and services.

Solution: When you have a Scrooge in your chair take these steps:
  1. Don’t take it personally. It’s not about you so get over it.
  2. Show empathy: “Mr. Scrooge, the cost for your treatment is X amount. That is not open for discussion. What is open for discussion is how we are going to support you in making financial arrangements to pay for what is the right treatment for you.”
  3. Demonstrate support for whatever decision your patient makes, even if he or she gets up and leaves.

The Shopper

Punch: These patients go from office to office trying to find the orthodontist who tells them what they want to hear at the price they want to pay. When this happens, you feel as if a precious hour or more of your time was wasted when it could have been better spent attending to a patient who is serious about you as their orthodontist or playing Candy Crush.

Reality: No one wants to be made a fool of and definitely no one wants to be swindled. You can relate to this feeling every time you take your car in for a tune up and the mechanic comes back with a thousand dollar tab claiming you’ve got hoses and belts that are all cracked and broken. When people have limited understanding and knowledge of something that can come with a high price tag, it’s normal to want to get a second opinion.

Solution: Instead of resenting patients who are Shoppers, welcome it, encourage it! You’re going to win either way. If a patient sees another orthodontist who is less expensive, willing to discount their fees and happy to do less work, that type of patient isn’t someone you would do your best work with anyway. Next! There is a chance the patient could come running back to you. Look at the Shoppers as a chance to create a win-win-win situation— for you, your team, and the patient.

The Know-It-All

Punch: This type of patient comes into the office with lots of questions and all the answers. They ask question after question as they painstakingly complete each inoffice form, and then do what they want anyway. They refuse X-rays because they argue they cause cancer and any reasonable dentist doesn’t need them. Recommended treatment is met with sarcastic comments and “that’s not what I read on the Internet.”

Reality: Someone who comes across as a Know-It-All really is someone who has high fear. They are a fearful patient disguising themselves as a Know-It-All control freak. What sets these patients apart from other fearful patients is that their abusive and abrasive tone can make it very difficult to offer any kind of empathy. Nonetheless, when approached in the right way, these Know-It-Alls can become your most loyal patients.

Solution: Since Know-It-Alls are really fearful patients, the main objective is to gain their trust so you can open their minds to a new idea. Follow these tips to win them over:
  1. Pick your battles. When a patient shares information you know is misguided, you don’t have to get defensive and correct them. If it doesn’t pertain to treatment, let it go.
  2. Be open, not defensive, and ask permission. If there is information a patient believes and it is untrue and it is hindering them from accepting the treatment that is right for them, ask them if they are willing to talk about a new perspective on the subject. Turning a compliant patient into a committed patient is all in the permission.
  3. Be confident and deliver softly. You know your stuff so be confident, on the inside. On the outside, make sure your body language isn’t engaging the patient in a heated debate. Sit eye level, cross your legs, hands in your lap, shoulders slightly rounded, tilt your head, look them in the eye and speak at a moderate level.
  4. Know you’re not giving in; you’re winning over. When you bite your tongue, and it’s likely you will with Know-It-Alls, remind yourself that every patient has the potential to be a great patient. It’s all in how you interact with them.

The Guardian

Punch: Parents, grandparents or guardians bring kids into the office with a predetermined list of Doctor-Dos-and- Don’ts. They demand exceptional care for the beloved child while refusing to complete all office forms, rejecting the need for X-rays, and hovering over your shoulder while you maliciously try to insert a mirror into the child’s mouth looking for evidence of why they are a bad Guardian.

Reality: Guardians come with high fear. Being that there are two reactions to fear—flight or fight—you are encountering a person in natural fight mode as a response to fear. Those who have flight responses don’t bring their kids into the ortho office unless they have to. I’m sure you can relate to taking the offensive approach when your kids, pets or family members are involved. It’s a natural reaction when we are protecting someone we care about.

Solution: Building trust is an important component to deescalating a situation with a high-fear Guardian. Start with simple chitchat and some light humor to lighten the tension. If the Guardian continues to display fear-based behaviors, ask to speak to them privately and directly ask them about their tone. Reassure them you have the best intentions of making the appointment a positive experience for the child and you need their help in ensuring that happens. Discuss how to work as a team and empower the Guardian to act differently in spite of their fear.

The “Why”er

Punch: You walk into the op, sit down and start your normal chitchat. You quickly realize this will be no ordinary visit. Every other word coming out of the patient’s mouth is “why.” Why did they have to fill out all those forms? Why did they have to take so many X-rays? Why, why, why?

Reality: “Why”ers are analytical thinkers. As a professional you most likely share this similar trait. “Why”ers want information so they can process their environment, prepare themselves for making decisions, calm their emotions and feel rest assured that they have all the facts. What is most difficult about “Why”ers is that they use the word “why” to start questions and why questions are the least effective questions to ask, but they are also the easiest so people have a tendency to overuse them. When a question starts with “why” it requires the responder to justify themself and automatically puts them on the defensive. It’s unavoidable as it’s the semantic make up of the word “why.”

Solution: Here are some concrete actions you can take with a ‘Why’er:
  1. Listen for the “why.” When a patient consistently asks questions, especially “why” questions, they are an analytical thinker and are searching for information. They want facts first and won’t settle for anything less.
  2. Lead with “why.” If you suspect you have a “Why”er on your hands, then don’t wait until they ask so many “why” questions that you feel completely defensive. Lead with “why” information and beat them to the punch.
  3. Be patient. If you are running a tight schedule, the “Why”er can definitely derail you. Answering a lot of questions takes time. There is no rushing it. The positive is that when a “Why”er does have all their information, they turn into a “Yes”er.
  4. Make a note. Know that this patient will want to ask questions at every appointment. Make a note in the chart that you want an extra 10 minutes with them to avoid the stress of running behind in the future.
  5. Plant the seed. The team can help by planting a seed during confirmation efforts, “Mrs. ‘Why’er, we are looking forward to your appointment in two weeks. Please bring any change of information with you and of course Dr. Y is happy to answer any questions you have prepared for her.”

The Rejecter

Punch: New patient arrives and is handed the stack of in-office forms they refused to complete online. When paperwork is returned, all that is completed is name and rank. They decide which X-rays are necessary and reject the rest. You manage to make it through the initial consultation and explain how you’d suggest to proceed. They reject your offer and counter.

Reality: Rejecters have high fear and low trust. They control and dictate to reduce anxiety. Your processes, systems and policies often go against what they have predetermined unreasonable because they don’t understand the purpose behind it. Fear of the unknown is the Rejecters Achilles heel.

Solution: Working with Rejecters requires patience because building trust isn’t something that happens quickly. It takes effort and commitment from you and the team first. The Rejecter will want to see a demonstration of your efforts before they are willing to let go of their control. Creating win-win-win situations, in place of compromise, is another must for winning over the Rejector. When you compromise, someone comes out on top (win) and someone on the bottom (loses). Never a good situation. Winwin- win situations only happen when you feel as if you got what you want, the patient got what they wanted and there is a positive revenue for the office attached to it. Bottom line, don’t give up anything you will walk away regretting and don’t regret anything that is easy to walk away from.

  Author's Bio
Jen Butler, M.Ed., CPC, BCC has been working in the area of stress management and resiliency coaching for more than 20 years. As a national speaker and certified trainer, Butler has presented to thousands of business owners on how to reduce stress, increase engagement and earn higher profits. Currently, Butler works exclusively with dental professionals as a Master and Board Certified Executive Coach and Stress Management Consultant through 1:1 sessions, in-office consulting and small or large group trainings.

Jen Butler is available as a coach, consultant, speaker and writer. To learn more about her services and sign up for her monthly StressLESS newsletter, go to www.jenbutlercoaching.com. Take the Dental Stress Self-Assessment at www.jenbutlercoaching.com/quiz/ to find out your stress levels. Contact Jen Butler directly at 623-776-6715.
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September 2025
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