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continued from page 17 can't reveal any personal informa- tion, "you can say, 'Everyone has a bad day sometimes, but no matter what we're here for folks,'" Dr. Foster continued. "That lets the patients know you're compassionate about [the situation] but you've got it under control, and the sky isn't falling." Ms. Syler takes a more hard-line approach. "I just say anything involving patients is a private matter," she said. Worst-case scenarios Occasionally, a physician and staff will come across a patient so irrational and abusive that the above strategies will fail. In those rare instances, "divorcing" the patient from the practice may be the only option. But "the clinician cannot abandon the patient," said Dr. Banja. "This means that if the patient has a clear and obvious need for continued treatment but must depend on that clinician and only that clinician for care—because it would be unreason- able to expect the patient to get treatment from another capable care provider—the clinician is profession- ally obligated to grin and bear it and remain with that patient. Otherwise, he or she would be guilty of aban- donment. Then, if the patient's con- dition would worsen, the physician would be ethically and legally liable for allowing harm to occur." Luckily, there's typically more than one clinic that can meet a patient's needs. In those situations, Ms. Syler has a form letter she sends to patients, severing ties with the practice. Resources for physicians and administrators M anaging belligerent patients is challenging, but there are resources physicians and administrators can turn to for extra guidance. "In order to avoid legal ramifications, physicians can utilize HR Online, an ASOA member service that allows them to confidentially submit questions and receive advice from human resources experts," said Lisa Marie Romano, ASCRS•ASOA marketing manager. "Patient relations are also frequently discussed in ASOA EyeMail; physicians have the option to compare how other ophthalmic practices have managed similar situations. ASOA EyeMail is an online discussion list/forum that connects participants to consultants, certified ophthalmic executives (C.O.E.s), and ophthalmic col- leagues. Receive these services by signing up for an ASOA membership or a 3-month free trial ASOA membership. Contact asoa@asoa.org or visit www.asoa.org." On the empathy side, Dr. Banja recommended the following books: Jodi Halpern's From Detached Concern to Empathy; Robert Buckman's How To Break Bad News; and Albert Bernstein's Emotional Vampires. "[The letter] says we've deter- mined our office is not a good fit for them, and although we've enjoyed our time with them, we feel another office would better suit their needs," she said. "We give [patients] a list of other area practices they can go to, tell them we will cover them for any emergencies for 30 days, and wish them well." The obvious goal, though, is to never get to this point. Dr. Foster believes firing a patient does more harm than good, on both ends. "It's much better if the doctor remains an adult when the patient throws a tantrum and their relation- ship is maintained because in that process, the relationship strength- ens," he said. "The original treating doctor is generally the one in the best position to help the patient heal. If the relationship breaks down and the patient goes somewhere else, his anger and frustration can hinder him from healing and finding a reso- lution to the problem. In that initial grievance, the doctor can remain calm and work on a pathway to a solution, and the patient tends to heal much faster and in the long run have a better result." OB Editors' note: The sources have no financial interests related to this article. Contact information Banja: jbanja@emory.edu Foster: gjlfos@aol.com Syler: sylervl@mcdonaldeye.com 18 Ophthalmology Business • October 2012