Address Angry Patients with the L.E.A.R.N. System

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By Larry Golson, OD

In our office, we pride ourselves on thoughtful care of our patients. We treat each patient as a guest in our home. We also manage expectations when it comes to aspects of a patient interaction such as insurance coverage, cost and the time it will take for their eyewear to be ready for dispensing. Despite our best efforts, once in a while we have a patient who gets upset with us. Whether the patient is justified or not in their complaint, we take these situations seriously and try to ensure that these patients leave our practice with a positive feeling.

LEARN How to Manage Angry Patients
We take the L.E.A.R.N. approach to managing angry patients. The acronym stands for: Listen, Empathize, Apologize, Rectify and Notate. I don’t remember where I came across this handy acronym, but it suits our practice’s process for addressing patient service difficulties. Ensuring patient complaints are handled effectively is essential to encouraging returning patients who are loyal and refer others–and generate additional practice revenues.

Listen
I’ve found that upset patients don’t calm down until they feel like they’ve been heard. In fact, taking a few minutes to calmly listen to the patient is often all it takes to resolve their anger. People frequently just want to feel like someone has listened to them. The anger stems from the fact that they feel like they’re talking and no one is bothering to listen or absorb what they’re saying. To avoid disrupting other patients, we ask the patient to follow us into a closed room in the office, so we’re not having the issue play out in public.

Here is what we might say: “I understand. We’d love to help you with this. Please follow me.” Once in the room with the closed door, we then ask the patient: “How can we help you today?”

We find that if the patient’s anger is at an eight or nine on a scale of 1-10, it has usually dropped down to no more than a five after they get a chance to explain to us what the problem is. Typical issues causing anger might be progressive eyewear that they are not happy with because their eyes have not yet adjusted, unrealistic expectations about their insurance coverage or maybe a dry eye patient who is finding that they simply can’t wear contact lenses comfortably.

Empathize and Apologize
The first thing we do, regardless of whether the issue upsetting them is our fault or not, is empathize: “I’m sorry you feel that way, and I’m sorry this happened.” I instruct my staff, or team, as we call employees in our office, to always at least apologize that the patient is experiencing discomfort or disappointment, whether or not we are at fault. I take a cue from Walt Disney, who famously said, “It’s not our fault, but it’s our problem” regarding unhappy patients who may be unsatisfied with their experience with your business even though you didn’t do anything wrong.

For instance, for the patient with dry eyes whom we are struggling to find an effective contact lens for: “I understand that you are disappointed. It’s frustrating not to be able to wear your contacts like you did in the past. You have developed dry eyes, as we discussed, so we may not be able to find a contact lens that will enable you to wear contacts as comfortably as you used to, but we are going to continue to try.” Once patients realize the issue is not entirely in your control and that you are trying the best you can to help them, they generally understand and the anger resolves itself.

Rectify
If we genuinely did something wrong or made a mistake, such as putting the wrong prescription in a pair of glasses or giving them contact lenses with the wrong prescription, then rectifying is simple–we apologize, acknowledge we were at fault and correct the error at no additional cost to the patient. However, rectifying the issue causing the anger becomes trickier when the issue has nothing to do with a mistake on your part–when, rather, it’s a function of a patient having unrealistic expectations.

Some doctors, as a knee-jerk reaction, will offer to give patients their money back. Our office used to do that, too. But I realized that patients often don’t expect that from you. So, instead we say: “We really appreciate you as our patient and your trust in our care. What would you like us to do to make this situation right for you?” In this way, the patient will dictate what he feels will alleviate his issue, which oftentimes, is less harmful to the practice than a full refund. If it is a case of unrealistic expectations–like the progressive patient who wants unattainable vision or the severe dry eye patient who wants to wear contacts the way she used to, at times we receive an unexpected response. The patient will break down (sometimes in tears) and you’ll find that they really aren’t that upset about the glasses or the contacts, but rather that a life event like a death in the family or financial difficulties have pushed them to the edge, so that they can’t deal with what would ordinarily be minor discomforts or issues.

In essence, you have to take off your doctor hat and put on your therapy hat: “I’m sorry you’re going through all that. I can’t imagine how hard it must be. Don’t worry about your glasses. We’ll keep trying until we get you the best vision possible. We may not be able to return your near and distance vision to what it was when you were in your twenties, but we’re going to do the best we can.” After all, we can all attest that the practice of optometry is 60 percent eyecare and 40 percent therapy/psychology.

We make sure at that point we are on the same page with the patient about what the resolution will be: “OK, so we’re going to recheck your eyes to make sure we have the best prescription for you and then make another pair of progressives that gives you your best possible vision. We will do this at no additional cost to you. How does that sound to you? We want you to leave here happy.”

Notate
We file what we call a Quality Assurance Report after the issue has been resolved. This report, which is saved as a Microsoft Word document, describes the situation, why the patient was angry, what was discussed with the patient and what the agreed-on resolution was. We discuss the incident at our next Monday morning meeting with the team at large, including not just what happened and what we did to satisfy the patient, but how we can prevent the same issue from arising again in the future. Whether it’s a patient’s unrealistic expectations or a genuine mistake on our part, the most important thing is that we learn from it.

It is worthwhile mentioning that there are times when we sense that a patient is taking advantage of our kindness and/or manipulating us. When this happens, we do not follow the above recipe, but instead take a more protective practice-centered approach. However, our experience is that this is a rare occurrence. I believe the vast majority of our patients are inherently good and simply want to be cared for with kindness and regard.

In closing, take patient pacification seriously at your office, at times swallow your pride and watch your practice grow. As with most things in life, managing angry patients is less about being right and more about being effective. Give patients a good reason to choose your office over the one(s) down the street, and they will in turn tell their friends, family and co-workers about the amazing care they received. On multiple occasions, our unhappiest patients have become our most outspoken advocates.

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Larry Golson, OD, is the owner of Envision Eye Care Optometry & Eyewear, an independent optometric practice in Asheville, NC. To contact him: drg@myenvisioneyecare.com.