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How To Deal With Unhappy Or Difficult Patients

There’s a nice article in the May issue of Plastic Surgery Practice that discusses how to deal with unhappy or difficult patients. No matter the area of medicine or surgery, you’re bound to have one or two of these patients over the years. It never hurts to learn or review tips in dealing with them.

In the article, Rima Bedevian interviews Julie Ann Woodward, M.D., chief of the oculoplastic and reconstructive surgery service at Duke University:

…how to successfully deal with them -– with compassion and humanity without allowing them to “run you over” or manipulate a difficult situation into a potentially litigious one.

Dr. Woodward provides a helpful checklist for doctors.

We all have them –- not even the very best physician can deny this. I learned many of the tips described below from observation during my fellowship, from talking with colleagues, and from personal experiences:

PREOPERATIVE STAGE

1)  Slightly downplay expectations –- eg, “Laser skin resurfacing will not get rid of every wrinkle. You may still need some fillers.”

2)  Talk in numbers and give percentages whenever possible –- eg, “Twenty percent of patients may need an adjustment with this procedure.”

3)  Stress the time required to heal.

4)  Beware of a patient who abuses your staff’s time. If so, tell her, “I’m sorry, the staff and I can’t meet your expectations.” 

5)  If a patient seems uneasy and difficult, encourage them not to do the surgery. The money you collect from a difficult patient will not be worth your time.

POSTOPERATIVE STAGE

1)  Never disagree with what a patient sees is wrong, even if you do not see it at all.

2)  Remind the patient that healing can take from 6 months to a year.

3)  Take action –- If the patient does not like the look of their scar, inject a small amount of steroid or make an appointment 4 to 6 month out for a touch-up. In my experience, most patients will be happy by then and will not even want the touch-up.

4)  See the patient with increased frequency and show that you care. Call them frequently. Don’t be afraid to gently touch the patient’s arm in a calming way. The worst thing a physician can do is to send the patient away for a month and hope that they will cool down. Even if it is stressful for you, ensure the patient will return frequently.

5)  A happy patient will tell two friends, and an unhappy patient will tell everyone on the planet via the internet.  As unethical and inaccurate as we know these websites can be, they are here to stay. If a disgruntled patient posts a negative comment on a website, contact five of your happy patients and encourage them to post positive comments to push the negative comment down on the webpage.

6)  Consider doing touch-ups either for free or for a nominal fee –- but set limits. Do not give free Botox/Dysport touch-ups. These patients will want free touch-ups every time. They will “doctor shop” the entire medical community to locate the practices willing to give freebies.

7)  Maintain positive interactions with your colleagues so that you can refer patients for second opinions. Ask them in some cases to see patients with worrisome outcomes.

DEALING WITH ANOTHER PHYSICIAN’S UNHAPPY PATIENT

1)  Never say anything bad about another physician. The patient will naturally seek the physician with a higher level of self-confidence and who does not speak poorly about colleagues. Negative comments about colleagues will usually come back to bite you.

2)  Disgruntled patients who come to you from other practices will probably be unhappy with whoever treats them, even if you dramatically improve their situation. You may want to encourage that patient to return to the physician who did the original surgery.

3)  Consider giving a friendly call to the physician who did the original surgery to let them know you have seen the patient. Mention that you supported that physician’s original work. You might establish a new referral source from this call.

4)  Never return a patient’s money. Most lawyers will say that patients will view this as an admission of guild, and it usually is an excuse for them to just go out and complain to more people.

REFERENCE: Bedevian, R. “How to Deal with Unhappy or Difficult Patients,” Plastic Surgery Practice, May 2010, pp. 26-29.

*This blog post was originally published at Suture for a Living*


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7 Responses to “How To Deal With Unhappy Or Difficult Patients”

  1. Cheryl Handy says:

    This article denies the possibility that the physician or surgeon may have . . . dare I say . . . made an error. Perhaps the patient seeks a second opinion or another physician or surgeon because the original surgeon denies the error or won’t help the patient.

    This is almost scary similar to my situation at Duke in Sept 2010. And the advise given above is why it is now Feb 2011 and I have dead tibia, fevers, vomiting and cannot get a surgeon to help me. The surgeon at Duke tried to fix the bone infection in Sept 2010. At discharge, I told him that the wound was opened. No one at Duke would look at the opened wound. Literally.

    And when I went to UNC and Cleveland Clinic, the surgeons called the Duke surgeon and the Duke physicians and surgeon told UNC and Cleveland that I was crazy, non-compliant, etc. But the clinical fact remains that I have dead tibia and bone infection.

    At some point, physicians need to stop being scared of being sued and start caring about the patient. Stop protecting each other and care about the patient.

    I have been suffering for 5 months because the Duke surgeon did not take responsibility for the fact that the wound was open at discharge. Someone at Duke should have looked at the wound instead of telling me “there is nothing else we can do for you except put you on antibiotics.” I am not a doctor but the wound would only remain open if the infection was still there. And, that proved to be true when 3 weeks after the surgery radiographic tests demonstrated that portions of my tibia were dead.

    Once a doctor becomes so scared of being sued that he or she takes the above advise instead of caring first and foremost for the patient, it is time to stop practicing medicine and return to research.

  2. rlbatesmd says:

    Cheryl, I’m sorry for how you have been treated. I agree with this “At some point, physicians need to stop being scared of being sued and start caring about the patient. Stop protecting each other and care about the patient.”

    However, the article does note “Never disagree with what a patient sees is wrong, even if you do not see it at all.” To me this means, you must listen to the patient.

    I hope you find someone who will listen to you and help you.

    Ramona Bates, MD

  3. Cheryl Handy says:

    Sadly, no one Duke would listen. I have terrific surgeon and physicians at Johns Hopkins. But the delay in Duke providing treatment means I am too poor to get treatment. I need multiple surgeries. I had to sue Duke for intentional torts.11-CVS-5432 in Durham County.

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Richmond, VA – In an effort to simplify inpatient medical billing, one area hospitalist group has determined that “altered mental status” (ICD-9 780.97) is the most efficient code for use in any patient work up.

“When you enter a hospital, you’re bound to have some kind of mental status change,” said Dr. Fishbinder, co-partner of Area Hospitalists, PLLC. “Whether it’s confusion about where your room is located in relationship to the visitor’s parking structure, frustration with being woken up every hour or two to check your vital signs, or just plain old fatigue from being sick, you are not thinking as clearly as before you were admitted. And that’s all the justification we need to order anything from drug and toxin screens, to blood cultures, brain MRIs, tagged red blood cell nuclear scans, or cardiac Holter monitoring. There really is no limit to what we can pursue with our tests.”

Common causes of mental status changes in the elderly include medicine-induced cognitive side effects, disorientation due to disruption in daily routines, age-related memory impairment, and urinary tract infections.

“The urinalysis is not a very exciting medical test,” stated Dr. Fishbinder. “It doesn’t matter that it’s cheap, fast, and most likely to provide an explanation for strange behavior in hospitalized patients. It’s really not as elegant as the testing involved in a chronic anemia or metabolic encephalopathy work up. I keep it in my back pocket in case all other tests are negative, including brain MRIs and PET scans.”

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“As far as medicine-induced mental status changes are concerned,” added Dr. Fishbinder, “We’ve never seen a single case in the past 10 years. Today’s patients are incredibly resilient and can tolerate mixes of opioids, anti-depressants, anti-histamines, and benzodiazepines without any difficulty. We know this because most patients have been prescribed these cocktails and have been taking them for years.”

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As for the nursing staff, Griffiths offered a less glowing review. “It’s unfortunate that our nurses seem preoccupied with urine testing and medication reconciliation. I think it might be time for us to mandate further training to help them appreciate more of the medical nuances inherent in quality patient care.”

Dr. Fishbinder is in the process of creating a half-day seminar on ‘altered mental status in the inpatient setting,’ offering CME credits to physicians who enroll. Richmond Medical Hospital intends to sponsor Dr. Fishbinder’s course, and franchise it to other hospitals in the state, and ultimately nationally.

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