Doctor Patient Relations

Set Protocols to Resolve Conflicts

By Thuy-Lan Nguyen, OD

July 20, 2016

When you interact with people all day, as ODs and their staff members must do, conflict can occur. A simple misunderstanding, or a response from doctor or staff that comes across as hostile, can spark a patient-staff dispute. I’ve learned in my 14 years in practice to reduce the chances of strained interactions, and to quickly resolve them when they do occur.

Recognize Potential Trouble Areas

Every doctor, every practice will have disputes and misunderstandings between doctor and patient. Many disputes are minor. The most common disputes involve a patient’s bills and insurance benefits. Many doctors will hear patients venting about high co-pays and insurance denials. Other common disputes for optometric offices involve delays in receiving glasses and contact lenses. And many patients often get frustrated with doctors when their medications are expensive.

Accommodate Differing Personalities

Sometimes you cannot avoid disputes with patients, no matter how hard you try. I find the best way to avoid misunderstandings is by understanding the personality of each individual patient. I’ve learned to categorize patients into four main personality types based on a book, Personality Plus, by Florence Littauer. In general, patients can be categorized as: “Popular,” “Powerful,” “Perfect” or “Peaceful.”Each of these types of patients is driven by different wants, needs and motivation.

Popular: Wants to have fun and be popular all time.

Powerful: Is driven by a need to be in control.

Perfect: Wants life to be orderly and organized.

Peaceful: Wants to avoid conflict at all costs.

Each patient is different, so you cannot communicate with every patient the same way. By understanding what drives each patient as an individual, I can communicate with them in a way they will understand and respond well to. This helps me to avoid the majority of disputes and misunderstandings. For example, if I am running late, and I’ve kept a “Popular” patient waiting, I try to compliment them or tell a joke. But that won’t work with a “Powerful.” For those, I say: “I know your time is valuable, but now you’ve got my undivided attention, and I’ll get you taken care of right away.”

Communicate Key Information to Opticians

The hand-off of the patient from doctor to optician is critical. No matter the personality of the patient, I first I educate my patient in the exam room. When it comes to their optical prescription, I never say the word “options.” I always prescribe features and explain benefits to the patient. For example, “I know your job requires a lot of time on the computer, so I’m going to prescribe lenses to filter out harmful blue light from digital devices. This is going to reduce the eyestrain that is bothering you, make your vision clearer and potentially protect you from harmful eye diseases in the future.”

Then, when I hand the patient off to the optician, I repeat my recommendations in front of both optician and patient. And, finally, I ask the patient and optician if either has any questions about my prescription. My opticians loveit because they don’t have to “sell” or convince a patient to buy something. The optician is filling the prescription as the doctor prescribed.

Build One-on-One Relationship with Patients & Allow for Questions

When I see patients in my private practice, I don’t have a scribe. That’s why the hand-off is critical. But when I teach, I always have a student with me. It’s common for the patient to ask my student questions after I leave the room. If I’ve taught my students well, the message is still consistent. Again, some patients just need repetition before the message finally sinks in.

Train Staff to See It From Patient’s Perspective

The key to calming an angry patient is empathy. Train staff to listen and try to understand what the patient is going through. This may not be easy if one is feeling attacked. Even with the most experienced and trained staff, the doctor may need to step in and help smooth out disputes and misunderstandings between the staff and patient. While I want to make the patient happy, I also need to keep my staff happy. There’s nothing that breeds malcontent in an employee more than if they think their superior is not supportive. So, I try not to second guess, or disagree, with my staff in front of a patient.

For example, I had a frustrated patient arguing with my receptionist over scheduling an appointment. The patient wouldn’t accept that I was booked for a couple weeks. They insisted on speaking to me right away at the front desk. After letting them vent their frustrations, I put my hand on my receptionist’s shoulder and told the patient: “I’m sorry that you have to wait to get an appointment to see me, but she is in charge. What she says, goes. The only way you can get an appointment to see me is by scheduling it through her. If she tells you my next available opening is in two weeks, I suggest you take it, and I’ll be happy to take care of you.” The patient conceded and stopped arguing. But from that moment on, my receptionist was more confident, she smiled more, and paid careful attention to my schedule. My days began running smoother. It was a win-win for everyone.

Provide Guidelines for Staff

A doctor should provide their practice manager and staff with guidelines on handling misunderstandings and disputes with patients. In some cases, just acknowledging a patient’s anger can help defuse it. I recommend training the staff to speak more softly and slowly to an angry patient. Train the staff to say “Yes, it’s awful that your glasses were delayed due to the insurance lab’s error. I know you need your new glasses and you are frustrated without them. I’m here to help.”

I would also recommend taking an angry patient away from the open areas of the office where other patients can hear and witness disputes. Invite the patient into a more private area where they can sit comfortably. Small gestures can often go a long way in calming down an angry patient.

There should be consistency throughout the entire office team. For example, a clear return and refund policy should be established in writing and given to each patient at point of sale, even if that policy is “No Refunds.” A doctor also needs to establish guidelines for a late policy on appointments. The staff should know what to do if a patient shows up 10, 20 or 30 minutes late for a scheduled appointment. There is no absolute right or wrong answer, but each doctor has their own comfort zone, and that should be understood by the entire staff.

Drill Staff in Resolving Disputes

I recommend having staff meetings and performing role-playing exercises to practice handling difficult situations. For example, role-play the angry patient who complains about the cost of their glasses after they have already been ordered. Practice explaining features and benefits over and over again until it becomes second nature. First, role-play the worst case scenario with the patient leaving angry. Then discuss how things could have been handled better, and practice the best case scenario.
Review insurance benefits until you can explain them logically for an average person to understand. If an employee is second guessing themselves, or constantly needs to ask someone else for clarification, the patient is more likely to be frustrated with everyone in the office, including the doctor. When a patient is angry over their insurance co-pay, the front desk should follow a script: “Yes, it’s terrible how the cost of healthcare is getting higher. It’s getting harder and harder for patients to handle it, but it’s also getting worse for doctors. Your insurance is a good plan, but it requires you to pay a certain amount. I wish we had more control over it, but unfortunately, this is what your insurance dictates.”

Take Advantage of Teachable Moments

Every patient dispute is a potential opportunity to train staff and become a better team, even if the dispute was not resolved with the patient, and they ended up leaving angry. Learning how to manage patient disputes will also make you and your staff better at taking care of the happy, thankful patients that you see.

Give Staff Members Leeway to Resolve on Their Own

The ideal scenario for a doctor is when an employee has managed to resolve a patient dispute reasonably without the doctor getting involved. For example, if a patient is unhappy with their vision with their new glasses, and the optician determines that their was a problem with the lens measurements, and simply orders a remake on her own. The optician should be given freedom to problem-solve, and fix the patient’s problem, without asking the doctor’s advice or permission.

Thuy-Lan Nguyen, OD, teaches at Nova Southeastern University College of Optometryand works part time as an associate at We Are Eyes in Boca Raton, Fla. To contact her:


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