When patients defect: A case study in emotional intelligence

It’s not uncommon for patients to switch primary doctors within the same practice, but the decision can feel like a defection, emphasizing an important conversation about keeping patients first.

A new case study from the AOA Ethics and Values Committee, titled “Patient Requests a Different Doctor in the Practice,” looks at the professional ethics involved in navigating the delicate situation. While that situation might seem like an affront to the doctor ‘losing’ a patient, explains author and Ethics and Values Committee member Timothy Wingert, O.D., the decision may be not only of benign origin but also of benefit to the patient and the practice itself.

Three common reasons for a doctor-patient change might include:

1. Supporting practice efficiency. In this case, shifting patients to a new doctor within the practice might dually ease the crowded schedules—and associated stress—of established doctors while also helping integrate the new doctor into the group. This shift allows the practice to serve patients in a timely manner.
2. Leveraging professional expertise. Intrinsically, group practices with multiple doctors afford an opportunity to emphasize individual doctors’ areas of expertise, be it contact lens, glaucoma, etc. This alignment by patient type allows for best possible patient care.
3. Acknowledging patient preference. Sometimes patients simply request or prefer specific doctors, relating or gravitating to a doctor with whom they are more comfortable. This choice affirms patient autonomy and self-determination of care.

Dr. Wingert argues it’s a question of understanding and utilizing “emotional intelligence,” namely empathy. Not only is empathy crucial in any successful doctor-patient relationship but it’s also a powerful contributor to the acceptance of diversity. This is key as the Optometric Oath affirms doctors will provide care for diverse populations “with concern, with compassion and with due regard for [patients] human rights and dignity.” Moreover, the Standards of Professional Conduct reiterates that doctors have a responsibility to treat patients—and colleagues—fairly and without prejudice.

So, how about our doctor whose patient found better rapport with a colleague? It’s nothing to take personally but realize this is a patient benefit afforded by the group practice setting. In other words: it’s value added.

“Just as adding additional services to the practice brings more value to the practice and the patient, bringing new personalities and perspectives to the practice adds value to the practice and to the patient care setting,” the case study notes. “By having the patient see a provider with whom they are more comfortable, the clinical care of that patient is improved.”

Arriving full circle, where the health of the patient is of utmost importance, the patient’s self-determination of care in this case further reinforces the principles espoused in the ethical conduct of doctors of optometry.

“The doctor of optometry must remember that in patient care, the primary concern is always what is best for the patient,” Dr. Wingert says.

Read the full case study on the AOA’s EyeLearn Professional Development Hub.

Have questions to an ethical debate?

The AOA Ethics and Values Committee routinely produces hypothetical case studies concerning ethical challenges and how best to approach such situations based on the AOA Standards of Professional Conduct, AOA Code of Ethics and the Optometric Oath. Access these case studies through AOA’s member-exclusive, centralized education portal, the AOA’s EyeLearn Professional Development Hub.

Have an ethical challenge or question you wish to share? Submit your idea or a case description to legal@aoa.org. The case description may be reviewed by the AOA Ethics & Values Committee and featured in future Ethics Forum discussions.