Street Smarts
Dealing With the Problem Patient
Hold your tongue, stay in control and you may well keep your patient.
BY DAN BECK, O.D.

RECENTLY, I WAS IN MY OFFICE while one of my technicians was screening the first patient of the day. After what I thought sounded like the four horsemen of the apocalypse barreling down the hall, the tech stormed through my door and proceeded to tell me what a complete lower posterior body orifice the patient was. Obviously, she didn't put it quite that way, but this is a family-oriented journal, so I have to tone it down a bit. After trying in vain to calm her down, I grabbed the patient's record and, with a smile on my face, headed toward the encounter.

I love dealing with difficult patients. This may sound strange, especially to students and recent grads, but difficult patients often provide the hardest challenges and, ultimately, the biggest professional rewards. By staying in control and following a few simple rules, you can ensure that any patient, no matter how miserable, will leave your exam room happy.

Maintain Direct Eye Contact

We've all been taught it's important to look people in the eye when addressing them. However, maintaining eye contact can be difficult when people are upset or yelling. Nevertheless, try to look patients in the eye when they're unhappy, not only because it shows you're not intimidated but also because it conveys that you won't cave in to their every demand.

Let Them Talk

Allowing patients to vent their frustrations is a great way to calm them down. Listen to what they're really telling you. Often, as patients ramble on, it can become clear that their problems may have nothing to do with their eyes. Stress from other issues in their lives may be what's really bothering them. Once they've let off steam, fixing vision problems usually is quite easy.

Give the Patient Control

Many people feel happy only when they're in control. Sometimes, these types of patients are uncomfortable with their refractions because we're in control of the testing. When I encounter such patients, I allow them to physically move and manipulate the phoropter knobs until they "dial in" their best correction.

Some doctors would have a real problem letting patients touch the phoropter, but it may be the only way to give patients the sense of control they need to feel good. Also, patients will rarely complain about eyeglasses made from a prescription they chose themselves.

Learn From These Patients

We all have to deal with difficult patients every day. Instead of letting them get you all worked up, view these encounters as opportunities to solve problems and hone your communication skills. I have to go now. I think I hear Mr. Johnson yelling in exam room one.