To the Editor:

The Staff Management article “Remember Even Angry Customers Are Always Right” (September 1997) offered some excellent advice but left out one of the doctor's responsibilities: discharging the disruptive patient. Sometimes the patient problem is a problem patient.

Treating patients with empathy, understanding and respect is certainly important; TLC can stand for Tactics to Lessen Confrontation. We must recognize, however, that some patients demand so much that they simply cannot rein in their rage, reason or recognize good care. We can do less to control the anger an irate patient spouts than we can to build the trust and praise our satisfied patients spread amongst their friends. Likewise, it is more difficult to find and more important to keep devoted personnel than demanding patients.

Patients are not customers in the customary sense. I hope family practice does not become just another service industry in our consumer culture.

The customer may always be right, but the doctor is always responsible. Our drive to solve problems and our desire to be all things to all patients sometimes shades our judgment. Part of our professional duty is to set limits. Some patients are best served by insisting that they find a practice where they can share reasonable respect.