Article Date: 10/1/2005

difficult patients
How to Deal with Difficult Patients
Turn these problematic people into loyal patients for life.
Managing Editor

As 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.


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.

Donna 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.

For 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 Dr. Miller.

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 face.

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.


Staff Paints the Picture

Most 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 discontent.

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