When to Fire a Patient – and How

What do you do when a patient causes your practice distress and disruption, and can’t be satisfied by reasonable solutions? Maybe you should fire them.

Exceeding a patient’s expectations with every visit is our practice goal. We nearly always succeed in meeting that goal. But once in a while a patient can’t be satisfied, and causes such a disruption that we take the most drastic step: We “fire” them.

There will always be patients who are not happy. They typically have been to numerous offices, and not one office has met their needs. We train staff and doctors to be prepared to be “doormats” in the service industry. We stand up to verbal or sexual assault, and defamation of character, but do give patients the benefit of the doubt and apologize many times when it is most likely not our fault.

Our staff does a good job knowing when to come find the doctors to determine if further action with the patient is necessary. We can’t stop patients from posting bad or negative reviews online, but we can be polite and courteous in  difficult moments. Surprisingly, many people just want to be heard. We have never gotten a negative review that I know of after firing a patient. Always fire in love. A book that has been a helpful guide for us in handling challenging patients is “Love Works” by Joel Manby.

We should let go of more patients than we already do. We probably fire 1-2 patients a year, and there are times when we would be justified in firing the patient, but choose not to. We see ourselves as people who are not perfect, and believe that a bad interaction with a patient often results from a difficulty in that patient’s life, and we are just receiving the side effects of their bad marriage or financial problems. Grace is extended a lot in our office.

>>Click HERE to download three key situations when you might fire a patient>>

Set Protocol for Potential Patient Firings
The owners have the final call on firing a patient, as any legal ramifications from letting a patient go will fall on the shoulders of the owners. We ask our staff to communicate the story to myself, or my partner, and we will discern actions to take. Our managers and doctors know when they should alert us from examples we have given them of the types of situations in which a patient should potentially be fired.

Managers will initially interact with the patient, so that all avenues of  pursuing harmony are taken, but if that doesn’t work, they present the story to my partner or I for next steps. We usually obtain a history on the patient from the doctor in our office caring for them, and will find out if the patient is in a tough place in life. Sometimes special circumstances result in us extending grace when otherwise we would not.

Knowing When to “Fire” a Patient
We once had a mother who kept returning her son’s glasses complaining of “manufacturer defect” when the damage was clearly the effect of the son not caring for the glasses. We completely understood and empathized the first time, and communicated to the mother that we can warranty the glasses, but future pairs might not be as easy to exchange since the damage did not appear to be the result of a manufacturer defect.

The first time the mother came in with the broken glasses we went out of our way to provide a replacement, but we educated the mother that we might not be able to replace it again. This mother returned multiple times with all kinds of stories, and when staff said they could not warranty the damaged glasses, she insisted on seeing the doctor. Once she visited with me, she said my staff was mean and not cooperative with her (I knew the whole time my staff went out of the way to help her because I was a part of the process of helping them make decisions on how to handle the situation).

During my conversation with her I decided she was not a good fit for our office, and told her this. I told her that if she would like a referral I would be happy to give it to her. We cordially parted ways. I followed up with a letter thanking her for her previous business with us, and apologizing that we could not meet her expected needs. I referenced a couple of other reputable ECPs she could visit nearby, and then offered to send her records wherever she would like them.

We do not communicate to another OD or OMD that the patient was difficult at our office because I don’t assume that the patient going to the next office will have the same problems. There are so many variables to not being a good fit between a patient and office. I usually let the patients pick which doctor they would like to transition to, and in my letter to them, I recommend other good ECP offices in town.

Protect Your Staff from Harassment
A staff member once came to me and told me patient John was showing her inappropriate pictures in the optical on his phone. I listened to the story and told the staff member that John’s behavior was unacceptable, and that I would visit with the patient.

The patient came in a month later and I took five minutes to tell John: “One of my staff members approached me saying that you received some pictures on your phone that you thought would be good to share with her, and the pictures made her uncomfortable.” I listened to his reasoning, then said, “I understand that we all have the freedom to do what we would like. At this office we value and respect women, and to show pictures like you are talking about is not acceptable here. This first time I thought it would be best to acknowledge how we feel, John, because I really enjoy taking care of your eyes and seeing you on a regular basis to manage your glaucoma. If this should happen again, I would have to ask you to see another doctor outside of our office, and I don’t want that to happen. Does that make sense?”

He received it well and we haven’t had issues following our conversation. Setting difficult situations up to potentially have consequences requires visionary thinking to map out in your mind what could happen. This directs you to communicate to patients what the outcome of certain behaviors will be. Make sure they understand that you don’t want to have to let them go as patients because you, the doctor, value your relationship with the patient.

The main legal concern we have is abandoning a patient who is under chronic medical eyecare. In these situations we will make the referral and schedule the patient to see the new doctor. We will continue to manage the patient until they have been seen by the new doctor. Otherwise, the letter will state when a patient’s next recommended exam is and how they can access all of their records.

Editor’s note: If you permit harassment of staff to continue to occur after you have been made aware of the situation, then you can be legally liable for creating an environment of harassment.

Prepare for the Patient Who Doesn’t Take it Well
In occasional situations you may have to escort individuals off the premises due to combative or abusive verbal behavior. In situations explained in this article, it is never a bad idea to seek the advice of a professional, whether that be an attorney, or consulting with the local police. Hopefully it never comes to that, but as the owner of your practice, always be prepared.


Chad Fleming, OD, FAAO, is a partner with Wichita Optometry, P. A. in Wichita, Kan. To contact: optometryceo@gmail.com


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