How to Deal
with Difficult Patients
Turn these problematic people into loyal patients
BOYLES, Managing Editor
ILLUSTRATIONS BY CINDY
an optometrist, you deal with many challenging scenarios: complex diagnoses, specialty
contact lens fits, surgical follow-ups, disease management, etc. But some of the
most challenging patients are those with difficult personalities. A patient with
a bad outlook can ruin your day. The bad news: You're always going to have to deal
with difficult people. The good news is that by solving the problem, you can turn
a complaining patient into a loyal, lifetime customer.
OR AGGRESSIVE PATIENTS
Start on the right foot
Greet any patient complaint with thanks. The reasons are two fold:
for every one patient who complains to you, ten walk away without saying a word,
according to Dr. David Seibel of St. Louis. View any complaint as an opportunity
to learn something about your practice.
The second reason is that simply by thanking the patient, you
set the tone for your discussion. "It's easy to become defensive when patients are
not in a good or easy mood, but this just escalates the problem and heightens tension,"
says optometrist David Kading, of Bellevue, Wash. "Lower your defenses and put yourself
in their shoes," adds Dr. Seibel.
"Patients don't complain for no reason," says Dr. Gary Gerber, president of the
Power Practice. Most times, when a typically pleasant patient is rude or abrasive,
it is related to something in their personal life and has nothing to do with you,
your staff or their visit to the office.
Suter, president of Suter Consulting Group, recently witnessed this kind of problem.
A woman came into an office demanding her money back because she didn't like her
glasses. Ms. Suter suggested the optician listen three times to the woman's complaint,
ask clarifying questions, then ask her to work together to fix the problem. The
patient ended up buying an entirely new frame and apologizing to the optician. She
explained that her husband had died six months ago and he'd always dealt with problems.
Some patients may not even realize they have been rude. "I ask
if there is anything we did to put them into this mood, or if there is anything
we can do to help. Often times, patients will become apologetic," says Dr. Kading.
Dr. Seibel says with this group,
"Let them make suggestions, but don't back down." Letting these patients tell you
what they think shows them you respect their opinion. "They don't care how much
you know until they know how much you care," he says. After you complete the exam,
discuss all the information you've gained, including their comments, then offer
a solution. "This way, you are reasoning with the patient, not necessarily agreeing,
but also not telling them what to do," Dr. Seibel says.
particularly stubborn patients, you may need back-up. Andrew Gurwood, O.D., in Philadelphia,
had a hard time convincing one 59-year-old patient he could no longer drive without
glasses. "He aggressively explained that he saw just fine ... he had no difficulty
driving." After several attempts to convince the patient of his need for correction,
Dr. Gurwood pulled out the Pennsylvania Department of Motor Vehicles visual standard
for obtaining and maintaining and motor vehicle license. "I sternly demonstrated
that his current uncorrected visual acuity did not meet the standard. To my surprise,
this explanation was satisfactory," Dr. Gurwood says.
Ever have a patient come in with
a cell phone surgically attached to his ear? How about a mom who is towing three
toddlers? Office policies can help modify a patient's behavior.
Or, you might accommodate the patient. In the "Management Tip
of the Week," an e-newsletter published by Optometric Management, Neil Gailmard,
O.D., explains, "When the phone rings, I smile and say: 'Do you need to take that?'
"If the patient says no, just ignore it. It will go to voicemail.
If the patient says yes, I say, 'I'll give you some privacy' – and leave the
room. This almost always results in the patient not wanting me to leave (who wants
to wait for the doctor again?), and he will cut off the call immediately."
Dr. Gailmard notes that it only takes a few seconds for the patient
to check caller I.D. "Be understanding," he says. "It only takes a few seconds.
The patient will see you as a warm, considerate professional."
Dr. Kading suggests dedicating an area of your office as a play-space
if you have the room. "We ask the parent if it is o.k. for the child to watch a
movie and munch on some crackers. Often times, this is a much needed break for a
parent," he says.
This patient group will only
listen to you because as the practice owner, you carry the responsibility. "When
you get into a really tough situation, only the boss can resolve the problem," says
You can't always change expectations, but you can impact the way
patients interact with you and your staff. Dr. Kading relates one such experience:
A patient came in for a routine exam and contact lens check. He commented that,
"all he wanted was a refill for his contact lens prescription." He had been non-compliant
with the prescribed care regimen and did not want to return for follow-up. He was
intent on getting out the door as quickly as possible. "I confronted the patient
on his attitude and asked him to come back next week with a more appropriate demeanor,"
says Dr. Kading. The patient returned with a kind tone of voice and a smile on his
This is a worst-case scenario
that many of you will hopefully never see. Even so, you should be prepared for the
possibility of a completely unmanageable patient. If a patient really steps out
of bounds, don't be afraid to ask him or her to leave the practice. "I always find
it best to part on good terms. You don't want them scaring off others," says Optometrist
Milton Hom, of Azusa, Calif.
You'll have to use your judgment in these cases. Document the
incident in the patient's record, along with any comments from witnesses.
"I will contact the patient in a couple of days to attempt to
reconcile any problems with the patient over the phone. I will see if the patient
wishes to continue care and schedule another appointment, or we will give the name
and number of various other doctors who can continue their care," says Dr. Kading.
Dr. Bob Levoy warns to be cautious, however, when firing a patient.
"Lawyers advise you should check with your malpractice insurer before taking any
steps related to dismissing a patient. There are important issues regarding abandonment
that need to be considered including those that exist within the confines
of a managed care plan's provider panel."
Firing a patient should always be your last resort. Keeping these
patients around is more beneficial to your practice than losing them. And, difficult
patients may walk away from your office singing your praises because you were able
to do what no one else has help them.
patients' perceptions of your practice are based on your staff. Staff members confirm
appointments, greet patients, help patients choose frames, and wish patients a good
day. So, it's extremely important that your staff reflects your office policies.
Dr. Seibel says, "Tone is set from the owner down. If you blow off your patients,
staff will follow your lead."
Consider this: A patient calls your office at
3 p.m. on Friday afternoon, complaining of itching and a discharge in her eye. Your
receptionist isn't happy about staying late. She questions the patient repeatedly.
After checking with you, she schedules the appointment, but the patient senses her
The patient arrives and the receptionist
continues to act as though she's inconvenienced. You determine the patient has a
serious eye infection and prescribe appropriate treatment. It's the last time you
see that patient.
While staff should ideally convey a
sense of caring, staff members should understand how to triage calls and work emergencies
into the schedule, says Dr. Neil Gailmard, president of Gailmard Consulting. Having
policies in place can stop this kind of interaction from happening.
If a staff member has been perceived
negatively, Pamela Miller, O.D., of Highland, Calif., asks staff to write a note
of apology. "The patient sees this as an admission of fault," she explains.
On the other side of this coin is your
responsibility to your staff who should have a clear idea of what constitutes
crossing a line. Dr. Bob Levoy of Rosyln, N.Y. says, "O.D.s need to recognize the
incredibly deflating message it sends employees if for any reason, they side with
an abusive patient while ignoring the rights and dignity of their staff."
Dr. Miller was recently forced to call
the police on a patient. "I have a legal obligation to protect my staff when there
is a perception or threat of eminent danger," she explains.
Optometric Management, Issue: October 2005