As optometrists, we have to make many decisions, both clinical and business-related. One of the hardest decisions is whether to fire a patient. Ironically, early in our careers we were willing set up any living body with an exam. As our careers advance, we see in rare instances that keeping every patient is not beneficial. With our core principles of practice in mind, I have personally had to request three patients see other providers. Below are three real-life examples of habitual patient behavior that signal it is time for that patient to be fired.
- Irrational requests – Unfortunately, some patients have unrealistic ideas of what health care should include. In rare instances patients will make requests that are irrational. For example, a patient might repeatedly request to have her prescription rechecked by the doctor, and then raises a fuss at the front desk because a staff member informs her additional charges may be incurred to carry out that request. That same patient also does not expect to pay for her glasses, even though she broke them. She also might raise her voice in disgust when staff refuse to continue to supply her with trial contact lenses because she neglected to show up for eher follow-up contact lens exams. After putting up with all of these irrational behaviors and arguments, we finally drafted an exit letter and gave her all of her patient records.
- Theft – When you have a kleptomaniac as a patient, you may want to ask him where he would like to have his records sent. Our practice lost condensing lenses, tonometer tips, dilating drops and anything else that would be considered customary to store in an exam room cabinet. We discovered after the second time this individual and his wife were in that they had a habit of cleaning out our cabinets. The patient was politely told that supplies and equipment seemed to disappear when they were in the exam room. We sent them a letter and sent their charts to another office.
- False accusations – A patient’s mother repeatedly accused me and staff members of intentionally messing up her son’s glasses prescription so we could charge her extra. She wrote me a nasty letter that included many inaccurate statements she claimed were spoken in the exam room about her child. We kindly asked the mother to have her family’s records sent to another office, and we gave her a letter explaining that our office is not a good fit for her and her family. Ironically, she was surprised that we would terminate them as patients. What we felt was ironic was that it took us as long as it did.
In all three situations above, we gave the patients second and sometimes third or fourth chances to redeem themselves after the initial conflict. Our office leadership firmly believes in forgiveness and second chances. However, after repeated incidents we believe some patients are not meant to be a part of our practice. Firing a patient is one of the difficult responsibilities of owning your own practice.
