From the moment some patients arrive in your office, nothing seems to suit them:

• Your parking lot charges too much.
• Your front desk staff has too many forms for them to complete.
• Your waiting room magazines are too old.
• The temperature in your exam room is too cold.

So why are some patients so grumpy?

I believe many patients come to us with a wall of fear around themselves. They are worried about the outcome of their visit. They are anxious that whatever they are seeing us about may be serious or life threatening.

Their attitude is their shield of protection from what they perceive as danger.

After you allay their fears and map out a treatment plan to help them, these people transform into some of your best patients, ever.

You know the ones I mean. These are the patients who bring in brownies on their next visit, with a note apologizing for their previous grumpiness.

There are, however, other types of grumpy patients: the ones who cannot be placated. We’ve all had patients who were born to be miserable.

They are never happy, no matter what you do. Free parking card? Updated magazine? Light blanket while waiting in the chilly office?

No matter. They are still grumpy.

Sometimes, you are able to slowly, painstakingly chip away at the iceberg that surrounds them, one visit at a time. And, after six months, you no longer need to pull out a blowtorch to melt the icicles.

Other times, you get lucky and you get a miserable patient who has a short-term medical concern. You are able to treat them quickly, despite their grumpiness. Fortunately, they are soon on their way.

Then, there are those other times.

You know the ones I mean: When the miserable patient needs extensive treatment or a surgical procedure.

They express their doubts at your ability to help them with a chip on their shoulder the size of Texas.

When I’m faced with such a patient I know will never be happy, I say, “I can see you are uncomfortable, and that makes me uncomfortable. Therefore, I recommend you see Dr. X for further evaluation and treatment. I will be available to you for the next 30 days for any emergencies. My assistant will give you Dr. X’s information.”

Write it down.

You will be glad you have it handy one day when you are standing face to face with a miserable of your own.

You will never, I repeat never, regret helping a patient find a more suitable doctor for his or her needs.

However, I promise you that you will always regret pushing forward when your instincts tell you to let them go.

Medicine isn’t about pleasing all of the people all the time.

It’s about caring for the people you can truly help.

That includes yourself.

Starla Fitch is an ophthalmologist, speaker and personal coach.  She blogs at Love Medicine Again and her upcoming book, Remedy for Burnout: 7 Prescriptions Doctors Use to Find Meaning in Medicine, will be available this summer. She can also be reached on Twitter @StarlaFitchMD.