Darrell E. White, MD , 2025-04-21 14:18:00
April 21, 2025
5 min read
Man, if I had a nickel for every time I have heard the phrase “the customer is always right.” I mean, am I right or am I right?
Originally “right or wrong, the customer is always right,” the phrase is credited to Harry Gordon Selfridge (thanks, Google). An American retail magnate who made his fortune with a department store in London, his philosophy has been almost universally adopted without question by businesses of all types. But is it true? Is the customer always right no matter the industry or circumstances?
For years, I have been attributing the quote above to the famous New York restaurateur Danny Meyer: “The customer isn’t always right; the customer has a right to be heard.” I could swear I saw it in one of his books, perhaps Setting the Table, which I read in the early years of SkyVision. Using the same Google-Fu that introduced me to Monsieur Selfridge not only failed to connect this quote to Mr. Meyer, but it is nowhere to be found in the search engine at all. Maybe I made it up myself many years ago. No matter, it not only sounds like something Meyer would say referring to restaurants and other hospitality businesses, but it also fits medicine in general and dry eye disease (DED) care in particular.
In an essay published in 2009, I declared that medicine is the ultimate consumer service business. Think about it: one-on-one service in which your only job is to deliver your best for that singular customer, that patient in front of you. Your ultimate responsibility is to make them healthier, but your real job is to do so in such a way that they also feel better. Feel good. Like the good caddy in my essay, the shoe salesperson at Nordstrom or the waitress slinging hash at a greasy spoon, successfully caring for a patient is more than just a good read on a putt, the right fit for a prom shoe or a perfect soft-boiled egg.
But what about the difficult customer or patient? What about the patient who is unreasonable? Someone who consistently fails to adhere to your prescribed plan and blames you for their failure to improve? How about the patient who is abusive to staff members? In my (yikes!) 35+ years of practice, cataract and DED patients seem to be disproportionately represented in these groups. This likely is due to high and sometimes unrealistic expectations in both. There also seems to be something about medicine generally that allows people to do or say things that they would never do in, say, a 7-Eleven buying a loaf of bread. How are we to deal with this person when they cross the threshold and enter our practice?
Here is one man’s opinion: Choices must be made.
In interviews many years ago, Danny Meyer expressed a management philosophy and practice in which he put his staff first. Each unit in his organization was built on a foundation of staff empowerment and support. Good pay. An atmosphere of courtesy and respect going in all directions up and down the organizational chart. By creating a culture in his restaurants in which every employee knew that the boss trusted them to deliver, his customers got great food and a great dining experience. In return, if things got dicey, Meyer had the employee’s back. Most customers were right most of the time, and dissatisfied customers were given a chance to express that. Most times, an amicable resolution was achieved.
I am a firm believer that a patient has a right to be heard. Whether giving us their take on symptoms or sharing their frustration about an outcome or process (including stuff like insurance coverage), I think we owe it to our patients to hear them out. There are limits, of course. It should go without saying that physical violence, threatened or enacted, is a one and done reason to dismiss a patient. So, too, at least in our office, is the use of profanity directed at staff members and doctors. These are lines that should not be crossed; they have given you no choice.
For all others, the best approach is the most effective: Give the patient an opportunity to tell you — you, the head honcho — what it is that is making them dissatisfied. When they are frustrated, upset or angry enough that your staff cannot do their jobs, it is up to you to let them be heard. This is a dry eye column; one of the traditional barriers that eye doctors claim when discussing why they do not have an interest in seeing DED patients is the perception that they take up too much chair time. I get it. This is the one time when you need to personally sit in front of a patient and just listen until they are done.
Once. After which, both you and/or your patient get to choose if your practice is right for them.
Patients are often frustrated by incomplete resolution of their symptoms. It is helpful to remember that dry eye is an incurable disease. This is part of your initial exam dialogue, and one need not feel compelled to repeat it at every visit. A discussion of nonadherence is similar. You are doing your best to help each patient. Everyone involved knows this. Repeating these conversations steals from all your other patients. A brief, kind reminder and then move on. If they cannot or will not, you both have a decision to make.
What about a patient who cross-examines you on every statement you make? Sometimes it seems like there is barely enough room for you, your patient and Dr. Google in the lane. Again, I ask for brevity, and I listen. Once. Sometimes they come up with something that is not half crazy, and I consult Dr. Google in front of them. Other times they present absolute nonsense or misrepresent otherwise solid data and turn it into rubbish. I have had new patients come in demanding a particular treatment. The easy ones tell you up front. The more frustrating ones make you go through the entire consult first. You have no obligation to deviate from your protocols. Dr. Google does not get a vote. You and the patient have a decision to make.
The hardest situations for me involve money. Your exam leads to one best therapy, and your patient is unable or unwilling to pay for the medication or treatment. I know that I do not get a vote, and I am OK with that. Maybe it is an expensive medication — we spent the time doing the prior authorization, the coverage was denied, and the patient wants us to do more. Perhaps the proper next step is an in-office procedure that is not covered by insurance, and the patient wants to negotiate. It could be something as mundane as explaining insurance coverage for the eleventeenth time. For me, after taking care of the basics like searching for coupons and utilizing specialty pharmacies, discussing costs I cannot control hurts my soul. Once again, both parties have a decision to make.
I have created a safe and supportive environment for my staff, and I have demonstrated that they come first. Hopefully, you have, too. I have listened to my difficult patient at least once. Hopefully, no matter how difficult your patient has been, you have, too. I have constructed reasonable limits on what we can or will do as a practice, as I am sure you have, too. At the end of it all, the difficult patient will have to choose whether or not we are the right practice for them.
And so will you and I.
- Reference:
- The ultimate consumer service business. https://drdarrellwhite.com/the-ultimate-consumer-service-business/. Published May 28, 2009. Accessed March 25, 2025.
- For more information:
- Darrell E. White, MD, of SkyVision Centers in Westlake, Ohio, can be reached at dwhite@healio.com.
Sources/Disclosures
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Source:
Expert Submission
Disclosures:
White reports speaking and consulting for Allergan, Bausch + Lomb, Sun, Tarsus and Viatris, consulting for Aldeyra, Bruder, Nordic Pharma and Thea, and consulting for and being an investor in Orasis and SpyGlass.
