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Would You Show This Potentially Difficult Patient the Door?

She looks like she’ll be a handful—but are there ethical considerations? And then there’s the dog…




EVELYN’S OPTICAL BOUTIQUE was closing in 15 minutes. Her wireless speakers were turned up and she was mopping paw prints off the floor when the front door chimed. Pee-Dee, Evelyn’s two-year-old Golden Retriever, gave his usual “ruff!” of acknowledgement.


Real Deal scenarios are inspired by true stories but are changed to sharpen the dilemmas involved and should not be confused with real people or places. Responses are peer-sourced opinions and are not a substitute for professional legal advice. Please contact your attorney if you have any questions about an employee or customer situation in your own business.


NATALIE TAYLOR is owner of Artisan Eyewear in Meredith, NH. She offers regional private practice consulting and ABO/COPE approved presentations. Email her at

“Hi there!” Evelyn greeted the woman warmly while killing the music. “How can I help you?”

“Ohh, I hope you can!” she replied dramatically, plopping down at the dispensing desk. From a large leather bag she pulled three quilted cases. Evelyn returned her mop to its bucket and joined her.

“My eyes are very difficult. I can never get a good prescription, or good glasses. They’ve always had to remake them, and the last place I went to remade them three times before I asked for a refund,” she said proudly. “But I heard from my hairdresser that you have a good reputation and I saw the ‘satisfaction guaranteed’ section on your website.”


Under her mask Evelyn was grimacing. She felt Pee-Dee’s fur on her ankle as he settled next to her. “Okay, tell me what’s going on with these,” she gestured to the cases on the desk.

“I’ll do you one better,” the woman said, handing over a packet of notes that had been stapled and re-stapled.

On the printouts of EHR notes and prescriptions, Evelyn saw a single vision high myope with multiple changes to cylinder power in one eye, a variety of lens materials, hand-written lens clock notations and more. She also noticed this stack came from two different optometry practices over the span of at least a year.

“Well, ma’am, these certainly are thorough notes,” Evelyn began. “You know I don’t have a doctor here, right? It would be impossible for me to adjust your prescription?”

“Yes, this prescription …” she grabbed at page three and pointed, “… this is correct, I see fine in the trial lenses, I know that for sure. When they’re in the frame though, that’s the problem. Doctors have told me my visual system is very sensitive,” she said confidently.

“And you have these frames out..?”


“Oh, I brought my old pairs that work well so you can see what they are,” she said. “Wait, where is the blue pair?.. it’s in my bag, hang on,” she said, reaching under the desk. Pee-Dee leaned heavily on Evelyn’s leg, then backed out from the desk. “Oh no!” the woman exclaimed.

“What’s wrong?” Evelyn asked.

“Your dog chewed on my bag – on the handle!” she moaned.

Evelyn was stunned. “Oh my gosh!” The woman pulled the bag onto the table to inspect it: Evelyn couldn’t tell if the bag was ancient or purposefully distressed, but it was clearly luxury leather. “Pee-Dee isn’t destructive, even at home,” she said, turning to watch her dog casually sniff his water bowl, oblivious to the accusation.

“Well, I mean, are you going to do something about it?” she asked, folding her arms.

Evelyn put her hand on the handle and didn’t feel any wetness, but there was a ratty patch on one end. In her head she wished she had closed the shop early.


The Big Questions

  • What are some tips and tricks you use to determine whether a patient is visually sensitive or simply difficult to please?
  • Should Evelyn offer to pay for a repair to the bag, even if she seriously doubts her dog did any damage?
  • Is it unethical to turn this potential customer away based solely on her self-reported history, in an attempt to avoid headaches?
Kevin C.
Glenview, IL

I simply wouldn’t make the glasses. I’d point out that the strap is not wet and Pee-Dee has never chewed on a shoe at home let alone a handbag. Seeing as she has had such a difficult time with her Rx, she would be best served in an office with a prescribing doctor who could make adjustments as needed. Time for a referral to the office down the street.

Mordy M.
Brooklyn, NY

When you go purchase something, even though you may be doing the business the biggest favor, a human being treats the business like a human being. It’s not good to open a bit late and close a bit early: My hours are 11 to 7:30, and 45 percent of all sales during that day occur between 11-11:30 and 7-7:30. People work all day and you need to accommodate them. If you remain open 30 or 45 minutes past closing, don’t worry about it — business before pleasure. That being said, an elderly business owner once told me that the worst customer is the one who doesn’t come at all, but I disagree. It’s definitely better to avoid bad customers. That woman was nuts. Forget about her and get on with your business. This ECP did not deserve to be treated like that.

Troy O.
Reno, NV

We have all had these patients and we have all wanted to beat our heads against a wall because of them. Since I have become an owner of the practice, I find it easier and easier to tell patients that we cannot help them. My staff is fantastic and they do great work but to knowingly create headaches like this is bad for morale and bad for business. Be honest and upfront before you take on a challenge you will regret. Try to find an office in the area that loves a good challenge and make the referral. You may want to give them a heads-up before the customer arrives. Be apologetic, but firm — there is no way I am going to pay for her purse. Life is too short to have that sense of dread every time you see or hear their name.

Rick R.
Girard, PA

I don’t know if there are any tips or tricks but as soon as she pulled out her “problematic” history that would have raised a thousand red flags.

You would think if her dog had chewed it, it would have been wet. I wouldn’t offer to pay under these circumstances.

I would explain that I doubt I could do any better than her previous attempts. I’d avoid that problem patient like COVID.

Texas S.
Citrus Heights, CA

Tell the patient that you would recommend that any Rx should be made by the prescribing doctor. This will save the patient a lot of gas driving back and forth with rechecks and remakes. No way would we fill this Rx. Sorry about your purse, but my dog doesn’t chew on anything except dog food. Let me show you to the door, we’re closing now.

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