Difficult Patients and the Dermatologist

Every doctor has patients they wish had never stepped foot in their clinic. This much we know. What we don’t know, and I am not sure I will ever figure it out myself, is how to handle them—either in the moment or after the interaction has ended.

Last week I had one such patient, who had scheduled a consultation for cosmetics but had a unique desire to not have pictures taken during the consultation. She was frankly uninterested in having any consultation at all, other than to determine if she liked me well enough to have a treatment. My patient coordinator came, tears in her eyes, after spending 10 minutes trying to figure out exactly what the patient wanted. We passed off the patient to our other patient coordinator for a second attempt at explaining our procedures and assessing the patient’s needs. When this also failed, I went to the room and tried to explain that we wanted to help her, and pictures allow us to show her before and afters should we proceed with neurotoxins or fillers. This was followed by another last ditch effort with the other patient coordinator, after which the patient eventually left in a huff, having uttered some choice words about the experience.

In my earlier years as a dermatologist, I would have sweated this type of interaction more and felt that it was essential to make this patient happy at any cost. Interestingly, in those days, the worst thing that could have happened was bad “word of mouth.” Now, of course, we have online review sites, such as Yelp!, all of which can be infinitely more problematic and persistent than “word of mouth.”

At a dinner with my whole family that night, my mom noted that I was preoccupied. I gave her the basic idea of these types of challenges and explained that it still bothers me when I can’t get through to such patients. My brother-in-law, a retired jeweler, related that he, too, had had several client experiences over the years that had started off poorly. In the situations where he had talked clients down from being abusive to him or his staff, he ended up wishing he had simply let them go, as they ended up causing nothing but trouble from that time onward.

His interpretation was incredibly insightful, and it was remarkably similar to many of my own patient interactions.

The take-home here (now realizing that most readers are likely much wiser than I am!) is that we aren’t all going to be matches. The “sorting hat” brings patients both to and from our offices, and this is probably a good thing. Instead of being unhappy about a lost patient, it is best to be happy that they understood they weren’t a match and exited the practice. In the end, even if we had done a cosmetic treatment in that session, the patient-doctor relationship would have been too fractured and fleeting to create a meaningful therapeutic alliance. If it hadn’t taken me 26 years in practice to fully realize this, that would have been even better!