Dealing with Difficult Patients Takes Patience

Frustrated DoctorA patient or family member is unhappy. Maybe she is displeased by the wait to see a provider, or felt ill-treated, or doesn’t like the way the business part of her visit went. What to do?

Several academic models are published in clinical and business literature, and a review of the Internet is extremely helpful; but most are simply based on the Golden Rule. If you were she, what would you want you to do?

  • Be grateful – First, be grateful your customer feels she can complain and you have the opportunity.  Thank the person for taking the time to speak and that this is an opportunity for you and your practice to improve.
  • Listen – Regardless of the issue, what the complaining patient perceives is real to her. Let the patient or family member tell you what she thinks is wrong. Don’t interrupt, patronize, or try to out shout her. Maintain eye contact unless you are taking notes, but be sure to focus your attention on her.
  • Don’t take it personally – The person is complaining about a problem, not you. Divorce yourself from any negativity she may have and listen for the real issue. Something else wholly unrelated to the issue being discussed or your practice may be behind the anger and frustration. Understand that some people feel that a complaint will only be resolved if they are aggressive.
  • Respond positively – Be empathetic. Apologize for the negative experience. When you have natural break in the conversation, reflect back what you think the patient or family member is saying. This lets her know you’re listening and helps clarify the issue. Give her a chance to correct your perceptions.
  • Learn as much as you can – Ask clarifying questions so you understand as much as you can. Let her know that the questions are not being asked because there is any question about the veracity of her concerns but that you want to be sure you understand what is happening.
  • Log the complaint – Keep a log telling who, what, and why. Leave space to document a resolution and a follow-up date. You can identify legitimate trends from an ongoing log of complaints, which can be traced to process, an error, a provider, or staff member. The complaint is an opportunity to improve the practice.
  • Assure follow up. Explain what will happen from there, and ask if she would like to document it on a simple form. Get contact information if you do not have it. Be certain to set a tickler to contact her via email, mail, or phone to communicate progress or resolution to her problem.
  • Act – Investigate the issue with providers and staff involved and help develop a solution.
  • Make everybody a winner – Seek the best outcome. By giving a little, you win a lot. If all parties feel like something has been conceded by the other, especially in a financial dispute, fairness prevails and the issue should be over.

Sometimes, however, the issue is unresolvable. What do you do then?

You can still listen. Many angry patients and customers just want to be listened to. Let her blow off steam, reflect back to let her know you are listening, and be patient. At some point, you will see an opportunity to explain why the situation cannot be resolved. Be patient; be kind.  Never once raise your voice or sarcastic.

Explain the reasons in a way she will understand and never once blame it on a rule, payer, or the government with explaining why. Take time, and look for opportunities to help your patient or family member even if the situation is rigid.

It takes energy, patience, and time, but listening, letting her know of her importance to your practice, and a mutual resolution may be one of the best referral tools you can have.

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9 Responses to “Dealing with Difficult Patients Takes Patience”

  1. Rena Hall says:

    There are times that a pleasant conversation can go south due to the office staff’s attitude, especially if a mistake has been made by the staff. In a recent incident, a family member received a bill from a doctor that he had not seen in 5+ years. When a call was made to the office, I politely explained that there had been an error in posting and that this member had not been there in the time frame billed. The staff member did all but call me a liar and was very argumentative. I ended up telling her how to research to find the error. The office manager called me to apologize two days later. So my addition to the article is, don’t think that your staff is above making errors. Politely tell a patient you will research and you will contact them back in a specified amount of time, then DO IT. But, please, don’t argue without the facts in front of you to support your stance.

  2. Sherry says:

    It’s true listening to the upset patient helps and they get the feeling that there is someone who is there. I make my patients as comfortable as possible and take action and get back to them with the outcome. It takes time, effort and patience but it works. What helps me to deal with difficult situation is that how I present to patients shows culture of my company and I am representing my company and I need to be the best more do in trying times. Accept mistakes, have a humble attitude and help in real sense to reach the solution which is in the best interest of all. After all we are dealing with human minds and the fact is we all are same and different in attitudes. Dealing with proper attitude and the intention is right, it works out in a positive way…

  3. Sandra says:

    This segment is a great reminder to all of us. I will be discussing this with my staff at our next staff meeting.

  4. Liz sanders says:

    I find that making patients a part of the quality assurance process enables staff to gain valuable insight into process improvement. Quarterly committee meetings with patient participation is valuable.

  5. Kerrie K. says:

    Great tips. I would also add three things:

    (1) Ask the person how they would like to see the issue resolved. You may not be able to procede as they wish but it lets them know you are being considerate of their needs and opinion.

    (2) That said, do not make “promises” instead, assure the person that you will do your best to resolve the issue. You don’t want to make the situation more difficult by having to go back on your word.

    (3) Whether or not the issue has been resolved, call the person and let them know where you are on resolving the issue. People appreciate being “kept in the loop” and it show that you are dedicated to fiding a resolution to the problem.

  6. Stephanie says:

    What are your suggestions when a patient complains of the charges and that the doctor only saw them for 5 minutes? I try to explain CPT guidelines in determining an appropriate E/M level in laymens terms but they still think it’s like going to the store and there is a specific fee for a specific problem.
    Also, what about when all of the complaints are about the doctor?

  7. Jennifer says:

    Stephanie:

    In response to your questions, here is what I do in my practice:

    For patient complaints about the level of billing or charges, if I can’t resolve the issue over the phone outlining CPT guidelines in simple terms as you do, then I invite the patient to schedule a time to come by and I will outline their record with the CPT guidelines and show them how we came to that level of billing. I often give them the analogy that it is very much like getting their car worked on. There are fees for the diagnostic tests to figure out what is wrong with the car, the cost of the parts, the cost of the labor and time to obtain the parts, etc., and all of which may be performed by different people. I will pull the CPT guideline and if necessary (depending on the patient), show them the E&M audit sheet validating the level of coding. We have a patient version that is a simplified version of our full audit tool. Usually, if you take the time to sit with them and outline things, they tend to calm down and realize that we are coding correctly.

    When it comes to complaints about the physician, that is where it gets tricky. I keep a complaint file and every month I have a meeting with the physician where I sit down and discuss the patient complaint with the physician and formulate a response. Sometimes, I give the physician reminders on customer service or coding rules, but we don’t get a lot of patient complaints about the physician personally (usually one or two a year). Most of the time, they direct their complaint toward the physician because they are unhappy with how their insurance processed their claim or the fact that they owe money for service that they thought was covered by insurance 100%.

    Hope this helps!

  8. Wendy says:

    Jennifer,
    Would you be willing to share your “patient version” of the audit tool that you use to explain to patients how you validate the level of coding? What a great idea!
    If you are, we could email you privately.
    Thank you for considering.

  9. marypaintsil says:

    i am new on here and it is good and great too i love it good one like this….This is my hospital format for my man..

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