Real Deal: The Case of the Toxic Patient Who Won't Leave

This article originally appeared in the Nov-Dec 2014 edition of INVISION.

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A high-maintenance client loves the doctor but
gives the staff grief. Is it time to dismiss her?

“Ms. Medeiros is on line four,” Debbie — the receptionist at Spear Vision Works — told her office manager, Samantha. “She sounds pretty upset, but she’ll only speak to you.”

“Thanks, Deb,” Samantha replied, stifling a groan and slumping her shoulders. What could the latest complaint be? Samantha quickly brought up Ms. Medeiros’ record to look for clues, but she saw nothing new. Taking a deep breath, she lifted the receiver.

“Hi, Ms. Medeiros, how are you?”

“Hi Samantha, not good,” came a stern voice. “Yesterday, one of your staff told me my contacts were in, but when I got to the office, only two of the four boxes were there! I left work early, and this is the third time this year that’s happened. Last time you told me you would fix it. I just don’t understand what keeps happening.”

Samantha winced. She’d told the staff several times that only she would handle Ms. Medeiros’ contact lens orders. But Ms. Medeiros wasn’t done. “Then, I just picked up my glasses at Lens Depot and I think the prescription is off!”

“It can be very tricky when you fill a prescription for progressive lenses at a different company. I’d need you to bring those glasses in with you so we can ...”

“So I have to come in twice in one week, for your mistakes. Is that what you’re telling me? And what about my missing contacts?”

Samantha would normally feel awful about any patient being in this situation. But every time Ms. Medeiros came to Spear Vision, disaster ensued. Frames were misplaced and lost, spectacle prescriptions were transposed, and one time staff neglected to alert her that an OCT fee would be applied toward her deductible. Samantha was beginning to wonder if Ms. Medeiros was just unlucky.

To make matters worse, Ms. Medeiros was unable to summon any understanding, patience or grace. Samantha knew Ms. Medeiros didn’t directly cause most of these problems, but she did have a knack for complicating matters and instigating drama within the practice. Every staff member knew if Ms. Medeiros called, whoever answered would be apologizing and sympathizing for at least 20 minutes — not very convenient in the middle of a busy day. Samantha recalled that twice in the past three months, Ms. Medeiros had actually made a staff person cry.

real life practice scenarios

As Ms. Medeiros continued to fume on the other end of the line, Samantha gritted her teeth and tried to remain poised. “I don’t want to be an inconvenience for you, Ms. Medeiros, but in this case I don’t have any other option. If Lens Depot made the glasses according to Dr. Spear’s refraction, the doctor will need to examine you again. Of course this will be at no cost,” she added. “We want you to be happy. And we’ll have the rest of your contact lenses here when you return.”

“I just don’t know what to do anymore,” Ms. Medeiros wailed. “I love Dr. Spear. He’s the only reason I’m still a patient at your office. I just wish he would stop hiring idiots who can’t do anything right ...”

Samantha interrupted. “Ms. Medeiros, I’m happy to work with you to resolve the problem with your glasses, but it is not acceptable for you to put down our staff.”

“I wouldn’t have to get so upset if you could just do your jobs! I’ve never had so many problems before with any of my other doctors!”

“If you are this unhappy with the practice, you may have a better experience at another optometry office.” Samantha was standing up now, with the phone pressed tight to her ear.

“I have no intention of leaving Dr. Spear,” Ms. Medeiros shouted over the phone. “But you can be sure I’ll be telling everyone online how incompetent his staff is!” She hung up.

Samantha felt nervous. Dr. Spear had already given her permission to dismiss Ms. Medeiros, but what could she do about a patient who refused to leave -- and what about the threat of negative Yelp or Angie’s List reviews?

T H E    B I G    Q U E S T I O N S

1. How could Samantha have handled this conversation better?

2. What can Samantha say or do to prevent Ms. Medeiros from posting negative reviews on the Internet?

3. Is it right to fire Ms. Medeiros as a patient, or does the practice have an obligation to continue providing her care?

Real Deal Responses


Tell the client that when her other contacts come in they will be mailed to her. Have her address concerns with the glasses she purchased elsewhere with that other office. If, after adjustments, the glasses still don’t work, re-check her in the chair. Be firm and stop with all of the over-apologizing. Obviously, she thrives on it. If and when she comes back for a recheck of the prescription, tell her (out of earshot of other clients) that you don’t see the relationship as a “good fit,” and that you hope she does find that good fit somewhere else. All of this should be handled by the office manager, not the doctor.


Say that posting a negative online comment may affect Dr. Spears’ reputation, so since she likes him, she might want to reconsider. However, if other reviews are high, then one negative post won’t be harmful. It can be an opportunity to reply online and show that the office is trying to resolve problems.


Don’t interrupt the patient. Sit there and listen until they wind down. When they are done, repeat back what they said and apologize for them having a problem. If this is handled correctly, Ms. Medeiros would not be elevating her threat level. And don’t fire her. She is not being non-compliant, and people can shop whereever they choose. If this job were easy, anyone off the street (or the Web) could do it. It is all about the customer service.


It is a tough call, but releasing this patient back into the marketplace is what I would do. It is never OK to belittle anyone. Mistakes happen, things fall through the cracks. This patient brings in a black cloud to the practice. Terminating her will give the practice peace of mind and show your staff that you appreciate them.


This patient had every right to be pissed off at the staff. They screwed up multiple times! What patient wouldn’t be upset? This doctor clearly needs to get his staff better trained or organized ... or replaced! We have had demanding patients. I just let one go last month. She would always require at least 10 pairs of trial contact lenses to re-fit her each year. Her glasses would need to be re-done at least twice each time. This is very different from the scenario you painted. It is way too easy to blame the patients because doctors are lousy at putting themselves in their patients’ shoes.


The manager did fine. Now it’s time for the doctor to speak to the patient. He should apologize for present and past inconveniences but assure her that the situation, which has undeniably resulted in her discomfort, is not common at the practice.


We have been in similar situations. I’m sure all offices have been. Often times the patient doesn’t realize how difficult they are being. We once had an instance where a patient had been giving virtually the entire staff a hard time. When the doctor confronted him, he apologized and things have been better.


High-maintenance people are hard to deal with, no matter what the situation. But if all of these things have happened, Ms. Medeiros has a right to be upset. The staff didn’t let Samantha handle the contact lens order after she told them to let her do so. Frames that are misplaced and lost are not the patient’s fault, nor is a transposed prescription. Should she be dismissed? No. It isn’t her fault that all of this has happened. It sounds like there are training opportunities in the office. The challenge to me would be to take this unhappy patient and show her that Dr. Spear does have an exemplary staff.


If the practice feels that this patient is sapping the life out of the staff and the practice at large, then the doctor should gently ask the patient to find another provider.


In most instances, if you remove your own emotions from the situation and kill the individual with kindness, they will usually dial it back and the situation will turn itself around. If the client is rude and disrespectful, you have every right to stand your ground, but never match their behavior.


I would be firm about the staff not calling until all the contacts have arrived. If there is a problem with the Rx, fix it. Just deal with the challenge and minimize the drama.

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