Dealing with nightmare patients


All of us have had to deal with patient perceptions on many subjects: insurance, contact lenses, spectacles, surgery, appointments. Anyone in practice has stories, and we all get better at dealing with these perceptions as we encounter them.

The views expressed here belong to the author. They do not necessarily represent the views of Optometry Times or UBM Medica.

All of us have had to deal with patient perceptions on many subjects: insurance, contact lenses, spectacles, surgery, appointments. Anyone in practice has stories, and we all get better at dealing with these perceptions as we encounter them. 

In talking with some colleagues about demanding patients, I wondered what my life would be like if the patients were right-about everything. 

In the patient’s world

Let’s start with insurance. In the “patients’ world,” my staff could read minds and magically know what the patient’s insurance plan covered upon presentation at the front desk.

My staff would do this even if the Internet were down and when patients refused to divulge their Social Security numbers. 

And of course, we could know what their vision plans were based solely on the flashing of flashing their medical insurance cards. 

Related: Patients say the darndest things

Patients could arrive “relative to” their appointment times but be seen immediately without any wait whatsoever. The exam would take five minutes, and dilation would never be required. 

They would be able to see the doctor at all times, even weekends, without planning ahead because our schedule would accommodate them, of course. 

Patients could be rude to my staff without consequence, refuse testing they felt was unnecessary, and leave a mess in my lanes. They would leave without buying materials because glasses and contact lenses are just as good from the Internet.

They would return when they could not see with their Internet glasses or contact lenses, so we would see them for free. 

Patients would wear the contact lens however they desired (because lenses never expire), rarely clean them, and blame the doctor when the lenses become uncomfortable. They would read without reading glasses and complain of headaches. 

They would complains of red, itchy eyes, and the grocery stores would never have enough Visine Clear Eyes on hand for the red-eyed masses.

While this seems both funny and sad-and certainly uncharacteristically pessimistic for me-I am now on a quest to modify these impressions one patient at a time. It is quite a challenge, but I think I can do it (one patient at a time).

As doctors we should doctor, but often we are caught up in computer problems, insurance problems, spectacle lab challenges, and other little fires that burn away at the edge of our happy days.

A much wiser friend once told me, “Surround yourself with people smarter than you to fix that stuff.” Message received loud and clear. Get a list of contacts to guide you with little fires, and make sure your staff knows where the list is located. 

Next: My Reese Witherspoon smile


My Reese Witherspoon smile

Demanding patients may be mildly annoying or extremely problematic, resulting in a “SMH” comment on ODs on Facebook. These stories are amusing to those of us reading the post because we have all been there, we empathize, and we all get optometry jokes that non-optometrists do not understand. 

If you do not want to deal with the annoying patients, consider hiring an office manager. Someone needs to be the “smile while deep breathing” person to address these problems when they arise. 

This person must perfect the art of smiling even in the ugliest of situations-at least in Alabama. If you not sure what I mean by that, please rent Reese Witherspoon’s “Legally Blonde” and watch closely as she smiles while tilting her head and looking demure. 

his tends to diffuse most folks, especially if you say nothing while you smile demurely. Or hang a disclaimer on the door reading, “No engineers allowed.” I think you will get more satisfaction from an office manager.

More blogs: ICD-10: Not quite the end of days

While I tend to try to please most patients, I am not one to back down when it may be dangerous for patient’s health or the health of my staff. So, when it comes to disgruntled patients yelling about whatever they deem so important that it must be yelled about, I tend to make them go through the entire complaint again, then repeat it back to them (while channeling Reese Witherspoon).

I then say, “I see you are very upset, and I am sorry for that. How do you want me to help you?” I personally love it when they continue to yell at me, and I get to say, “Miss/Ma’am/Sir, I am trying to help you, and you just keep yelling at me.” (Insert Reese Witherspoon smile.) That usually does the trick. 

Next: My quest


My quest

So in my quest, I will strive to gently educate patients when they make comments about the need for dilation (yes, I do want to make sure there is no detachment lurking back there), contact lens classes (yes, I do not want you and your child to end up in the ER because you can’t remove a lens), and the need for eye pressure testing (no, I have not used the air puff since 2001-get over it already).

Contact lens patients tend to be more challenging because patients so often tune out all of those recommendations we make during the brief exam encounter. My new goal is to address the biggest myth they mention during the exam and expel it-with emphasis. 

More from Dr. Swartz: Putting patients first with refractive surgery

If they are sleeping in their non-extended-wear lenses, I will act aghast, ask if they change their underwear weekly, and discuss refitting them into a lens that allows them to misbehave. 

If they buy generic solutions, I will discuss the benefit of using solutions with clinical efficacy rather than, “I am not sure what mixed with water” while reminding them of the fungal infection party a few years back had when with MoistureLoc (Bausch + Lomb) got pulled of the shelves. 

And when I am told, “I have been wearing them like this for years,” I will try not to get red faced and scream. Rather, I will take pictures of their nasty lenses, infiltrates, or corneal ulcer, and offer to send to them for their Facebook pages. 

I will then prescribe a very expensive medicine to diffuse my red face and need to scream. 

I hope to protect my staff from those who may get overzealous in their need for the perfect appointment time or those who were under the impression that the exam would take only 15 minutes.

I tend to become a mad mama bear when you cuss at my staff and may show my claws (while still channeling Reese Witherspoon so they don’t understand until they are driving home that I just verbally slapped them).

I will try to leave with each patient a little pearl of knowledge to dispel all of these myths so that by the time I retire, patients will act appropriately in all optometry offices, and all of my colleagues will have much better days.

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