Over the past few years, I've had to deal with extremely challenging situations involving “difficult” patients. This happens for any number of reasons, many of which are totally avoidable, and others that, as hard as we try, are not easy to resolve. Let's take a look at some of the reasons difficult situations arise and how we can avoid them. Sometimes, there is a solution that benefits all. However, there will be other situations when, as much as you may hate to do it, it's time to walk away from a patient.

Patients have higher expectations than we can deliver

These are probably the most difficult patients to satisfy, as you felt you could satisfy every expectation they had. They talked negatively about all of the previous physicians they had seen, and you felt your magic could be the end of all of their frustrations. The only problem was that, despite 100 percent of your efforts, you would only ever get a 50 percent satisfaction rate. This patient tried negotiating with you on every procedure, and promised to send you all of their 5,000 Facebook friends. You were assured they were waiting to see your patients' results, and the entourage would soon be lining up at your front door. I bet you're still waiting to see their first friend.

Solution: Send them on their way. You'll never meet their expectations.

Patients resist every treatment you suggest or recommend

You knew from the moment you spoke your first words that nothing you did for this group of patients would ever be good enough. There was always a reason that the procedure you suggested was not the right one for them. You heard that neurotoxins are a poison, that the last five syringes of dermal fillers all went away the next day, that their last laser hair removal either left them with a burn (or they still have two hairs left), that they were allergic to the skincare moisturizing cream the last doctor sold them, or that they only have four more doctors to get an opinion from.

Solution: Send them on their way. You'll never meet their expectations.

Patients create noise in your reception area

Negative Nellies have been complaining to your other patients in the reception area because they feel the need to be heard. It's a shame people have to feel important by complaining to others, but misery does loves company.

Solution: The moment this happens, escort them into a private area and try to resolve the issue, avoiding confrontation at all costs. Once you can make the patient feel as if their concern is important to you, they will usually calm down rather quickly and, in some situations, even become an advocate of the practice once they feel respected.

Patients are able to get the procedure cheaper elsewhere

You are in the medical profession… even though some of your patients feel you're in retail. Years ago, there were no daily discount sites; today they have become the chop shop of our industry.

The winners here? The patient and the sites themselves. Patients now know your competitors are offering the same procedures at much cheaper prices. Even board-certified physicians are offering these procedures at low-ball prices, using a smaller procedure as a loss leader to upsell patients for more expensive treatments or surgeries. You find that no matter what you do, the patient demands you either match the price or they will go to your competitor. Even your most loyal patients may not be your most profitable patients. Your patients are consumers, too, and you must remember they're entitled to shop around, make the best deal and haggle. It's up to you to make the correct business decision.

Solution: Weigh out all of your options. How important is this patient? Are they just shopping for the best deal each and every time, jumping from doctor to doctor? If they are loyal to you, try meeting them half way. If that is not an option, don't let your ego get in the way. You can't stay in business by offering cheap, low-ball prices. If you can combine the discount with other more profitable procedures, go for it.

Patients think follow-up treatment should be free

During the initial consult, you explained that the patient may need additional syringes of a dermal filler to correct those deep lines around the cheeks. You even told them they needed a package of IPL treatments to get the best results. Now, they came back for the follow up visit and are unhappy, letting you know the original treatment you performed did not correct the initial problem. As a matter of fact, they let you know, they can't even see a difference; they even asked all of their friends and they couldn't see a difference, either. They claim you never told them they would bruise and they would have to miss their daughter's wedding because they were so embarrassed and couldn't even leave the house. (Why are you laughing so hard? Is it because they just left your office and now they are sitting in mine?)

Solution: Hopefully you made notes on the previous visit, indicating you had told them they needed multiple treatments. Hopefully you had them sign a consent indicating possible bruising. Hopefully, you even took pictures with the lens cap off. Now, offer this patient a discount on any additional treatments necessary to satisfy their ill feelings. If you really feel as if they didn't get a good correction, then you may even offer them a free touch up.

Patients waited too long in the reception area

We usually find out about this right away, since the client is already there and had to wait longer than they expected. This happens when previous patients may have been running a little late and/or the previous patients added additional services during their visits. We can't and should never turn those added services away as they can become missed opportunities.

Solution: When this has happened over and over again to the same patient, and you know this has created a problem, and it was truly your fault, it is best to offer the client something in return to make them feel you are sympathetic to their feelings. In the meantime, re-evaluate how your staff is scheduling patients to prevent this from continuing in the future.

We must always remember we are dealing with a human factor, and like the science of medicine, no two people are alike; results and attitudes differ from patient to patient. It's all in how we handle people's feelings. When you go into a restaurant, and you may not be satisfied with the meal, it may not be because it was poorly cooked or had a bad presentation. It just may have been because it didn't meet you satisfaction or particular taste. The resolution is how the management of the establishment handled your particular complaint. It's all in how we right the wrong in the customer's eyes. In our case, it all about how we express ourselves to our patients and make them feel respected and valued.

Remember, it is our job to under-promise and overdeliver.

Jay A. Shorr is the founder and managing partner of The Best Medical Business Solutions, assisting medical practices with the operational, financial, and administrative health of their business. He is also a professional motivational speaker, an advisor to the Certified Aesthetic Consultant program, and a certified medical business manager from Florida Atlantic University. He can be reached at jayshorr@thebestmbs.com.