What to do when patients have unrealistic expectations?

In our series on Patient Satisfaction, I wrote mostly on the value of Patient Satisfaction and how we can exceed it to succeed in our practices.  But, what do you do when your patient has unrealistic expectations?  How can you satisfy such a patient?  That is what we’ll be discussing in this article.


Let me ask you a question, has any of these scenarios ever happened to you?


  • A presbyope wants you to prescribe single vision glasses for ALL his vision tasks. He doesn’t want bifocals with or without the line. He just wants his glasses to work like they’ve worked for the past 20 years and you have to make that happen.  What do you do?
  • A patient wants you to redo their glasses for the 3rd time, because they still don’t like the frame they picked.  They feel it’s your fault the glasses didn’t work the past 2 times because your optician didn’t explain to them that the 1st frame was too big and the 2nd frame was the wrong color. What do you do?
  • A patient doesn’t want to pay your service fees because they do not agree with your diagnosis. There is nothing wrong with their daughter’s vision. She can see just fine – even though she’s +3.50 OU.   Mom never worn glasses and no kid of hers will ever wear glasses. Besides, you’re not a real doctor anyway.  That’s why she doesn’t want to pay at check out because she wants to keep her money to go see a real doctor for a second opinion.  What do you do?
  • A high myope with a corneal hypoxia and neovascularization demands a prescription for contacts they can sleep in. She’s a news anchor on a local TV station and refuses to wear glasses because it will tarnish her “image”.  She also refuses to wear daily disposables, because she doesn’t have time to deal with the hassle.  She only wants contacts she can sleep in and demands you give her the prescription or else… What do you do?
  • A patient who constantly no-show for their glaucoma follow-up exams keeps asking for prescription drops refills. They’re already blind in one eye from glaucoma and is hanging by a thread in the other eye. What do you do?


I could go on and on… As ludicrous as these scenarios sound, we deal with situations like these every single day.  Raise your hand if you had a patient like this today!  If you haven’t had an encounter with a scenario like those mentioned above, just keep practicing and you will.  So what do you do?  How do you handle people with unreasonable requests? How can you satisfy an impossible patient?

Well, I’m glad you ask.  The short answer is – you can’t!  However, here are 3 things you can do to help you and your team manage demanding patients with unrealistic expectations:

  1. Create a Standard Operating Procedure (SOPs) manual for your office.
    • Standard operating procedures (SOPs) are step-by-step instructions that act as guidelines for employee work processes. Whether written up in numbered steps or formatted as flow charts, effective SOPs are complete, clearly written, and based on input from the people who do the job. When employees follow the SOPs manual for a particular job, they produce a product that is consistent and predictable.
    • SOPs allow employees to complete each task in the exact same way every time so that your practice can remain consistent.This will create a set of boundaries that spell out each party’s responsibility in the Patient Care Process.  Ultimately, this will relieve the pressure to succumb to the unreasonable demands of difficult patients.
  2. Train your team on the SOPs manual and how to implement it.
    • In order for your team to consistently communicate your office policies to every patient, they must be trained on the SOP.  This training will be costly, but it’s worth the time and the investment.  Because if you don’t have a manual to guide how your office handles patient request, your patients will create one for you.  And since each patient is different, that means you would operate according to a different set of rules every single time.  You can see how this is not practical!
    • Training your team on the SOPs manual will create peace of mind for you.  Not only does it take you out of the equation, it ensures that your team is handling these day to day issues the right way – your way.  Imagine what that would be like…  When you’re sitting eating lunch in your office and a patient comes with unreasonable requests, your team would not come running to you anymore.  They would run to the SOPs manual instead.  That means, no more calling you from the back to handle a difficult patient in the front!  What would that be worth to you?  That’s what training your team on the SOPs manual can give you – FREEDOM!
  3. Stick with it and do not compromise.
    • Do not flip flop.  If you follow the SOPs manual for some patients and don’t for others; you will create confusion for your team and your patients.  Why should your patients follow your policies if you don’t follow them yourself?  You team will not be confident when they go over those policies with the patients if they’re not sure you will back them up.  So, stick with the SOPs and do not compromise.
    • With that said, it is important to know that the SOPs manual cannot account for every possible situation.  That is why it should have steps for how to handle exceptions. An attorney friend once told me that a good law must always have a loop hole.  In your SOPs manual, you must create loop holes to give your team the freedom to use their best judgments in delicate situations.  Every office does this differently, however most offices assign an office manager to handle these delicate situations and to make these judgment calls. There’s no right or wrong way to do this, you just have to chose one and stick to it.

SOPs, are step by step instructions compiled to help employees function and to respond appropriately in a variety of scenarios. These are meant to increase efficiency, reduce miscommunications and manage unrealistic expectations. A standard operating procedure translates into consistency and uniformity; which in turn translates to consistent patient satisfaction.

Your team’s ability to handle difficult patients will improve your overall patient care experience and reduce your stress level.  A positive patient care experience means that your patient is more likely to recommend your practice to others and also more likely to come back again.  Creating a SOPs manual to guide your office operations is a win for you, your team and your patients.  So, let me ask you this – Do you have a SOPs manual?  If you do, great!  If not, don’t wait another minute, email me [email protected] and I’ll be more than happy to help!

If you missed the first article in this series, click here to read it.  So stay tuned for more!

As you enjoy these articles, please add your friends to the email list and leave a comment below.  Thank you for sharing!

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