I used to have these all the time
If you are fortunate (or maybe unfortunate) enough to work in a large hospital, you will deal with a lot of Medicaid patients. Now I'm not trying to start a flame war or any nonsense like that, but many of the folks in the area I first started practicing in were very much entrenched in the entitlement culture. Many were 3rd or 4th generation that had had Medicaid as their insurance and many felt entitled to everything a private party insured working individual would get. Many hated the red tape for getting appointments or hearing aids or tests approved by Medicaid (I hated this too as a practitioner). So it was a perfect recipe for patients to be angry and take it out on you.
What you always have to keep in mind even as a student is, you are the expert. You will know more than the patient. If you did not then you wouldn't be sitting on the opposite side of the table. Kill em with kindness usually works, but some people you have to realize will not be happy no matter what you do. How will you know? It will just take experience. Being male it is easier to get respect by most patients. It's very sad, but it's true. So I have no trouble being gruff when I need to be. I also think having experience working in nursing has helped me know when to turn the switch so to speak and be gruff.
Just remember never make threats with an unruly patients. You can't back up threats. You must present instead consequences. I've flat out told patients before that if they did not fix their attitude that I would no longer see them and did not have to see them if I felt they were a threat to me or other staff. This usually calmed most down because they realized that I would not take crap from them.
The other thing to remember is often times by the time a patient gets in your office or booth they've been through a lot of other places and red tape and are quite frustrated. Several patients I saw had reported their hearing problems to several physicians and never got referred or just sat for 4 hours to see the ENT before being sent up to see me. It happens. I usually try defusing the situation first by saying something along the lines of "I can see you seem upset. Tell me what is going on and what you would like me to do to help."
This usually takes them off the defensive and I give them about 5 minutes to vent. Then I explain what I can do, what I can't do, and more importantly I tell them what I will do and then I follow through with it. Often most places have a patient advocate you can deflect to if the situation feels out of your control.
The important thing is remain calm. If you appear rattled then the patient will own you. Stay calm and in control and the patient will know that you are running the show.
I recommend all students taking a confrontation management or conflict resolution course online. If you are in the VA system you can do these trainings online and for free.