By ShaUn Coombs, OD   |  PCLI—Olympia, wa

Ami Halvorson, OD

 

PCLI—Portland, OR

From the EDITOR   As cataract surgery outcomes and lens implant technology have advanced over the years, so too have patient expectations. However, when results fall short—whether expectations were realistic or not—some patients respond with frustration or even anger. In this issue, my colleague Shaun Coombs shares thoughtful strategies for navigating these sometimes challenging conversations.

I’m sure you’ve noticed that patient expectations for cataract surgery have increased over the years. When I started at PCLI 25 years ago, we only had monofocal IOLs. There was little discussion about refractive endpoints, and most patients were set for plano. They were generally very happy despite the technological limitations.

 

Heightened Expectations

Fast forward to today. We have a full menu of life-changing options, including advanced multifocal and extended depth of focus IOLs, the Light Adjustable Lens, and more. Patients also have access to an abundance of information at their fingertips. More than once, someone has asked about a new option I’m unfamiliar with. Naturally, with more options comes higher expectations—and while that can sometimes be challenging, it’s a challenge we gladly embrace.

Occasional Disappointment

Thankfully, outcomes are better than ever. Still, even with the best technology, careful counseling, and great results, we occasionally see patients who are disappointed or even upset. It’s our responsibility to manage ocular health and support patients when they’re frustrated or angry.

Handling these moments can be challenging. They’re often amplified by miscommunication, unrealistic expectations, or other sources of stress. But with the right strategies, we can navigate these situations—preserving the therapeutic relationship and our own well-being.

Strategies

1. Stay Calm and Practice Self-Regulation

Remaining calm is essential. Upset patients may be reacting to more than the immediate situation, such as their fear, pain, or past experiences. Being aware of our own emotional responses can help prevent escalation. Some approaches that I’ve found useful are:

• Breathe deeply – Take a few slow, deep breaths.
• Be mindful – Remain anchored to my core values, which foster empathy and patience.
• Be self-aware – Recognize my personal triggers and have a plan to manage them.
• Self-care – Get good sleep, exercise, and eat a healthy diet, which support emotional resilience.

2. Build Rapport Early

Establishing rapport with patients from the first interaction goes a long way in building trust. Those who feel heard and respected are less likely to become difficult later. My suggestions for doing this are:

• Personalize the interaction – Use the patient’s name, maintain eye contact, and engage in a little small talk if appropriate. Try to identify one thing about the patient that you find interesting or meaningful, even if you keep it to yourself.
• Listen with empathy – Show genuine interest in their concerns and validate feelings, even if you don’t share their perspective.
• Use supportive body language – Avoid crossed arms, sighs, or glancing at the clock. If I know an interaction is going to be difficult, I sometimes say “Three, three, three” quietly to myself, activating smile muscles before walking into the room. If I feel my smile fading, I say it again. It may sound silly, but it helps me reset my tone.

3. Practice Active Listening

Patients want to feel heard. Active listening means listening with the goal of understanding, not just to reply. A few tools I’ve found helpful are:

• Paraphrase and summarize – Repeating what you’ve heard helps ensure understanding and shows the patient they’re being listened to.
• Use reflective language – “It sounds like you’re frustrated that things didn’t turn out the way you hoped.” Statements like this acknowledge emotion without judgment.
• Ask open-ended questions – “Can you tell me more about what’s bothering you?” allows patients to share more context.

4. Set Boundaries with Empathy

While we aim to be empathetic, it’s also important to protect ourselves and others from disrespectful or disruptive behavior. Boundaries help everyone feel safe. Some ways to do this respectfully include:

• Use “I” statements – “I want to help, but I need us to speak respectfully.”
• Reinforce positive behavior – “Thanks for explaining that calmly—it really helps.”
• Focus on the behavior, not the person – Rather than labeling a patient as difficult, address specific actions. For example: “It’s hard for me to help when we’re speaking over each other.”

5. De-escalate When Needed

When an encounter becomes tense, it’s helpful to have some go-to de-escalation strategies. These might include:

• Lowering your voice – Speaking slowly with a calm tone helps diffuse tension.
• Acknowledging emotion – “I can see that this situation has been really frustrating for you.”
• Giving space – If needed, take a brief step back to allow the patient a moment to cool off.

6. Seek Support and Reflect

These situations can take a toll, so don’t carry them alone.

• Debrief with a colleague – It can offer both perspective and emotional relief.
• Reflect on the encounter – What went well? What could improve?
• Maintain life balance – Make space outside of work for rest, hobbies, and relationships. That recharge time matters.

In Closing

Managing difficult patient interactions is part of our professional calling. It’s not always easy, but it’s a skill we can grow. When we make a mistake (and we all do), reflect with kindness. Every encounter is a chance to learn and grow. In a world filled with tension and conflict, we are privileged to let our actions reflect kindness, patience, and respect—while helping people preserve the precious gift of sight.