Welcome to the Ethics Forum! The optometric profession has long recognized its ethical responsibilities to patients, colleagues, other health care professionals and the public. This forum provides an opportunity to review a hypothetical case study containing potential ethical challenges and includes suggestions on how one might handle the situation based upon the American Optometric Association Standards of Professional Conduct and Code of Ethics.

Feedback
If you have any questions on ethics, please submit them to EthicsQuestion@aoa.org. The AOA Ethics and Values Committee will respond to your questions as soon as possible. If you have an ethical challenge you wish to share, please feel free to submit a case description to ethics@aoa.org. The case description will be reviewed by the AOA Ethics and Values Committee and may be featured in a future Ethics Forum.

Strategies for the Disgruntled Patient
By Sandra Fortenberry, O.D.
Case Study No. 15

Nearly all optometrists and staff have experienced it, right? The disgruntled patient. The reality of day to day patient care not only involves taking care of patients' eyes, but also learning to interact with a vast variety of personalities. The episode of an unhappy patient probably happens more often than one would like to admit professionally. Even more alarming, in today's social media world, how staff and doctors react to each situation can mean the difference between a good or bad review. 1

Sample Scenario

You just finished with your 2 o'clock patient and are walking him up to the optical for a fitting. You notice there is a lady at the front desk who seems to be unhappy with the receptionist. What do you do?

Turn around and head back to the exam rooms, do not waste time intervening.

Walk up to the front desk to see how you can help.

Walk to the office manager's desk and ask her to go see what the problem is while you go see the next patient.

Both B and C are possible choices. If you do not have any more patients waiting, then B is an option. In offices where staff is limited then this might be a good choice. If you work in a very busy office, then C might be your better choice. 2

Let's Continue

You are a small office with only 3 staff (reception, technician, and optician) and you decide to intervene. As you walk up to the front desk what is the first thing you should do?

  1. Walk up behind the receptionist and ask, "What is going on here?"

  2. Walk up in between the receptionist and customer, listen for a moment to hear what is going on and then consider chiming in.

  3. Go directly to the patient and ask, "How can I help you? I'm the doctor here."

In this case, you may want to start with option B. It is important to listen to the full conversation so that you can know where to begin. Option A may present a feeling of overpowering the situation. Choice C can present a feeling of overlooking the receptionist and the work they have already put into the conversation.

More of the Situation

We find out the patient is upset because she made an appointment over the phone and "Was not told about an additional contact lens fitting fee!" The receptionist is apologetic for any misunderstanding, but your office policy is to charge for a contact lens fitting fee*. As you begin to recognize the situation, what should you consider doing next?

  1. Ask the patient to step over to a quieter part of the clinic. There you visit with her about the policies of the office and see if she would still like to be seen?

  2. Tell the patient up front that we simply cannot waive the fees and she should decide whether she wants the exam.

  3. Offer to waive the contact lens fee just this once and ask her to sign-in.

Here, option A sounds like it would be the best call although still might not have the desired outcome. Ideally, any dialogue from this point forward should be in a quieter part of the clinic or reception area. As we bring this patient over to a quieter part of the clinic there are a few techniques to utilize in order to hopefully diminish the situation.

  • First, ask the patient for their full side of the story. Oftentimes, just listening to a vent session can help the patient feel like their situation has been heard. It is important to not interrupt during their time. Giving them their few minutes can save time later.

  • Use empathy to convey to the patient that their complaint or problem matters to you. 3

  • Stay calm. It is probably not a good idea to say, "Let's calm down" to a patient. That might make things worse. It is important to not belittle or speak in a condescending fashion the patient.

  • Agree with the feelings of the patient with phrases like, "I can understand where you could feel like this is unfair. Unfortunately, I am unable to change the office policies" or "I really wish I could do something for you, but I cannot alter the pricing for you. I hope you understand this is an office policy that I cannot change." In addition, you might include in your explanation that all additional testing will have an additional cost, for example photos or a visual field. If needed, explain what a comprehensive exam does include.4

  • If you are the owner of a small business, then this is where things can get more complex. The patient might respond with, "Well, aren't you the owner? Can't you waive the fee this once?"

  • To which you might respond, "Yes, I am the owner, and this is a very small business. That is exactly why I cannot bend the rules. I must be fair to all my patients. I hope you will still give our practice a try and see that the prices are very competitive for the great service you'll be receiving."

  • Try to end the conversation on a positive note. Try to offer an ending, "Mrs. X, what can we do within our policy guidelines that will help resolve this for you?" This puts the ball back in her court and lets her know that you cannot alter policy, but you do want to make things right. 3

Optometrists must deal with disgruntled patients. Optometrists must learn to understand and coexist with disgruntled humans. Establishing a set of strategies ahead of time can help diffuse a potentially toxic situation with minimal disruption to clinic. 4

Much of what is said is in daily non-verbal communication. Be mindful of body language, as how one physically approaches a situation can say much about how one feels about the situation before a single word is uttered. It is important to remember to use positive body language. This can include direct eye contact, not crossing your arms and facing the angry human directly. 3,4 If feasible, stay at eye level with the person. Even having the patient sit down can reduce some of the distance between the doctor and the patient. This will hopefully allow calmer voices and promote a feeling of empathy.

Depending on the situation, it is important to document in the records any misunderstanding that took place. One should want to legally protect himself on down the road, should the need arise. Document the problem, the complaint, and what was the outcome. It is important to be succinct and accurate. Avoid using jargon or personal opinions of the patient in the chart, as these documents may be reviewed by the patient, insurers, or others. 3

Books and articles that help with emotional intelligence and communication skills are useful tools not only in the office, but also in life. Try utilizing part of the monthly staff meetings into a "mini book club" and choose books that can help the whole staff learn better communication techniques. Every person in the office must choose their own pathway and how they will handle day to day issues that arise in the clinical setting.2 Training can benefit clinic, staff, and personal lives. How people are made to feel in the office can make a loud statement about their perception of the office. Be sure your statement says what you want!

REFERENCES

  1. Myers, Danny. Setting the Table. New York, NY: HarperCollins Publishers; 2008.

  2. Bock, Laszlo. WORK RULES!. New York, NY: Hachette Book Group; 2015

  3. Gray MD, Ryan. 7 Tips for Handling an Angry Patient. mdmag.com. mdmag.com/contributor/ryan-gray-md/2016/06/7-tips-for-handling-an-angry-patient. Accessed December 2018.

  4. Bradberry, Travis; Greaves, Jean. Emotional Intelligence 2.0. San Diego, CA: TalentSmart; 2009.


About the Author:

Sandra Fortenberry, O.D., FAAO, ABO Diplomate, is a tenured Associate Professor at the University of the Incarnate Word Rosenberg School of Optometry. She is a graduate of the University of Houston College of Optometry. Dr. Fortenberry currently serves as President of the Texas Optometric Association and was named the AOA Young OD of the Year in 2013.

* Determining fee structures and amounts is the responsibility of individual optometry practices.