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 By Neil B. Gailmard, OD, MBA, FAAO, Editor July 13, 2011 - Tip #490 
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When the Patient Is Not Always Right


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I often receive emails from colleagues who present a specific situation that occurred in their office and they're not sure how to handle it.  These cases involve a patient who is dissatisfied with a product or service but is also being unreasonable in some way.  I love these challenging situations because it helps me check my own standards for customer service.  Read on for some tips that will help you and your staff manage these unpleasant confrontational situations.

An example
Many of the cases that are really annoying involve a time element on the patient's part that goes beyond reasonable behavior.  For example, a contact lens patient who returns eight months after the fitting of new lenses to report that the contacts are not working as well as they should.  The optometrist is willing to see the patient and prescribe new lenses, but practice policy calls for a new office visit fee to be charged.  The patient objects to the professional fee and says he will find a new optometrist if the fee is not waived.

The usual thinking is to not allow this patient to take advantage of the practice.  Doctors will reason that it's the principle of the matter that is important; not the office visit fee.  After all, doctors must charge for their time and expertise.  In fact, the practice may be better off without this type of patient.

The problem with the thinking above is that it's all from the point of view of the doctor or the practice.  It does not consider the patient's point of view.  The patient's point of view is not really of interest because if it differs from the doctor's - well, then it's simply wrong.

Let the patient win
This type of situation is one that a staff member will typically refer to the doctor and quite often the doctor ends up speaking to the patient directly about it.  A disagreement ensues and quite possibly some anger exists on both sides.  This kind of confrontation upsets the doctor and the staff.  It creates stress.  The doctor will think about it for hours.  The patient will stew over it and tell his version of the incident to family, friends and co-workers.

I would like to know more details about the patient, the fee system, the history, etc., but in general it is best to let the patient win.  Yes, I know there will be large percentage of readers who will be upset by my approach, but hear me out and rest assured that my conclusion is a smart business strategy that is aimed at making more money.  I'm not just taking the easy way out.

Your practice reputation
It's a clever strategy to let patients win because doing so quickly creates a reputation that your practice is great to work with!  From the patient's point of view, you are the best!  You operate a gem of a practice.  Optometrists are often concerned that their reputation will become that of a practice the public can take advantage of, but I disagree.  In fact I'm happy to let the public take advantage of me all the way to the bank!  Happy patients send more patients.  Happy patients return more often and buy more goods and services.

The second major reason to follow "the customer is always right" approach is that it creates the office culture you want.  Your office is less stressful and staff members are happier on the job.  Standing up to patients might stroke your ego, but it teaches staff members to say no and act tough to patients. 

How to back down gracefully
When a patient objects to your usual office policies or fees and you can tell they are sincerely unhappy, here is a good way to let him win.  Just say: "John, you are an important patient to my practice and we value your business very much, so I'm going to make an exception in your case and waive the office visit fee."  Then simply move on and don't make a big deal about it.  The patient may not show it, but he will be very happy and impressed.  You have just removed a great deal of stress for him as well.  Was it really that hard?

Don't sweat the small stuff
I assume these objections are rare.  If they are not rare, then there may be bigger issues in your practice that should be worked on.  But typically, the complaints in an optometric practice are a very small percentage of cases.  The cost of giving in is insignificant.  It is usually the doctor's ego that stands in the way, but if you can view this as small stuff and not worthy of upsetting the patient relationship over, you can come off as the hero.

Let's look at the big picture.  The patient is unhappy about something.  From his point of view, accurate or not, something you or your office did was not right.  He is not satisfied.  When you think of it this way, the right thing to do is make the patient happy.  And don't worry that it is not fair to all the other patients who do not complain; the point is that you will handle anyone who is not satisfied in the same manner.  Some people are just easier to satisfy than others.

Examine your vision
Many companies say they believe in great customer service, but that vision falls apart as soon as the going gets tough.  How you handle the unreasonable patient provides true evidence of your level of commitment.

Truly great companies, like Disney, Zappos, Ritz-Carlton Hotels, Nordstrom, Lexus, and many more understand the customer service philosophy.  Great service is at the core of how these businesses were built.  These companies get it.

Part of your management vision relates to your fees.  If you have a low fee structure, you really can't be the hero and let the patient win.  What I want to do to reduce to small stuff (and it really should be in the big scheme of your practice) will feel like big stuff if your profit margins are slim.  All of the great companies mentioned above have a higher pricing philosophy, except maybe Zappos and they are in a different price-value category because they only do business online.

What took you so long?
In discussions like this with a time element, I find it helpful to ask the patient (with no sarcasm or attitude on your part; just sincerity): "John, what took you so long to let me know about this problem?"  This does three things: 1) It implies to the patient that he has some responsibility as a consumer to let you know about dissatisfaction in a timely manner.  There could be warranties from your lab or other time sensitive issues.  2) The answer might provide you with some useful insight into one aspect of the situation that could make you be more understanding (wife has cancer or the patient was out of the country, for example).  3) It could help the patient see things from your point of view and be more open to a fee or a compromise.  Play this by ear; you will know how to handle it based on the situation.


Best wishes for continued success,

Read Past Tips Neil B. Gailmard, OD, MBA, FAAO
Editor, Optometric Management Tip of the Week


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Send questions and comments to neil@gailmard.com.

Dr. Gailmard offers consulting services to eye care professionals through Prima Eye Group; information is available at www.primaeyegroup.com.

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