Effectively Deal with Dissatisfied Patients
Make an effort to satisfy all of your patients and protect the livelihood of your practice.
By Stephen C. Spain, MD, FAAFP, CPC
As consumers, we have all experienced service that fell short of our expectations. Healthcare is also a service, and providers are not immunized against the occasional displeased patient. A provider’s reputation can make or break the organization, however; so great care must be invested to keep patients not only healthy, but happy, too. You may have heard the old business adage, “A happy customer tells a friend; an unhappy customer tells the world.” Thanks to social media, that’s true now more than ever. Let’s take a look at how you can effectively deal with a dissatisfied patient, should a conflict arise, without compromising your ethics.
Author’s note: In the context of this article, the word “patient” is an inclusive term that also refers to guarantors, parents of minor children, and significant others. Likewise, a “provider” may be an individual or refer generally to an outpatient care facility. The scope of this article excludes those serious situations where medical malfeasance, malpractice, fraud, or other glaring liability issues are evident. If you are not certain if you are dealing with such an issue, discuss the scope of the problem with providers, other managers, and/or an attorney.
Collect the Facts
Front desk personnel respond to the brunt of problems related to dissatisfied patients, and should be trained on how to effectively deal with such situations. When the level of conflict escalates beyond their ability to handle the situation, a practice manager may have to step in.
Begin by assessing the situation so you can come to understand what the patient is unhappy about. To do this, question staff members who interacted with the patient to gather as much information as you can on the events that may have led to the problem.
Your investigation may stop here. Sometimes it’s clear that staff acted or reacted inappropriately, or failed to follow office protocol. In these circumstances, it can be readily apparent that an apology is in order. More often, though, you’ll need to contact the patient to hear his or her side of the story before you can determine who’s at fault.
Approach the Patient
It’s never easy to contact a patient who left the practice upset or angry. Without communication, however, the issue will never be resolved. If the issue involves an egregious error, serious medical liability issues, or the suspicion or allegation of fraud or criminal intent, an attorney should be consulted. Otherwise, in less serious cases, it’s always best for you to contact the patient directly to get his or her side of the story. Email and text messaging do not convey the same level of interest and concern as a phone call. As hard as it may be, your next step is to call the patient on the phone. Be sure you have pen and paper handy to take plenty of notes about your conversation.
Determine the Issue
Start off on a positive note. For example, you might lead by saying, “I am glad that this has come to my attention because we always want to provide great service.” Be apologetic and conciliatory. By staying very general in your conversational style, you can apologize at this stage without accepting responsibility or liability. For instance, you could say, “I am so sorry that you are upset, and be assured your concerns are very important. We want our patients to be satisfied with our services. I would like to understand exactly what happened so I can work with my staff to prevent future problems.” People upset or in conflict are usually not prepared for an empathic and understanding contact, and responding in this manner will help to defuse the situation.
After you have the patient’s attention, get him or her to talk about the issue with open-ended questions such as, “Can you explain what happened?” Or, “What is your concern?” Make time for listening to the patient’s version of events. He or she is likely to be upset or agitated, and allowing the patient to vent is a good way to dispel his or her anger. Don’t call at a time when you know you will be interrupted by staff, it will only irritate the patient to be put on hold.
After thoughtful and empathic listening, “zero in” on specific questions you may have about the events leading up to the patient’s dissatisfaction. Be certain you have a clear understanding of the facts from the patient’s point of view and restate your findings to the patient for clarification and verification. Reassure the patient that you will review his or her concerns with the staff involved and that you will respond quickly to his or her concerns. Set a short (but reasonable) amount of time for you to complete your investigation, and give the patient an estimated time frame in which to expect your follow-up phone call.
Research the Problem
Now that you have the patient’s version of events, meet again with your staff to determine the true nature of the complaint. Be objective and make it clear to staff that your goal is to resolve the issue and improve the care experience of the practice’s patients.
By this time, you should know if the problem is with the service rendered by your facility, or if it’s due to patient expectations that were not met. If your facility is at fault, you’ll need to set protocols and procedures in place to be certain that future events of this nature will be handled differently. This requires education and counseling of the affected employees.
If your conclusion is that your patient had expectations that were not achieved, additional analysis is in order. Sometimes, services may not be up to par. Protocols or billing procedures may be outmoded or policies may need to be fine-tuned. Perhaps other facilities are offering enhanced services and it’s time for you to follow suit. Be introspective and open-minded in your analysis.
If you decide the patient’s expectations were simply unreasonable, share your findings with one or two coworkers or colleagues to determine if they concur with your findings.
Follow Up with the Patient
Now it’s time for a polite and professional follow-up phone call. If your facility is in error, convey your findings and apologize for the patient’s experience. Outline the steps you have put in place to ensure the problem will not be repeated. If you need to enhance your services to better meet the patient’s expectations, explain the improvements you are planning. If you have concluded that the patient had truly unrealistic expectations, you’ll need to tactfully explain this to the patient. This information may be difficult to communicate, and is not likely to be received well by the patient. Nonetheless, be firm and avoid argument or rehashing complaints.
When Dismissal Is Necessary
Occasionally, an obstinate or unreasonable patient may need to be discharged from the practice. If this is the case, be sure to do so in writing. The discharge letter should succinctly state that the patient is being discharged from care, but allow for 30 to 60 days for the patient to establish with a new provider (check with your state medical association for guidance). During this time, the patient should be seen for urgent or acute problems, medications should be refilled, and the discharge letter should explain this (see Sample Dismissal Letter). Send two copies of the letter to the patient, one with a return receipt request, and the other by regular mail. If the return receipt letter is refused, as is often the case, the fact that the regularly mailed letter was not returned as undeliverable is generally adequate proof of notification.
ABC Medical Associates
123 Harbor Drive
Anytown, Anystate 00001
April 15, 2014
8811 River Drive
Yourtown, MA, 00011
Dear Mr. Jones,
Regrettably, I am discharging you from my practice for thirty (30) business days after receipt of this letter. I will be available to provide urgent care or emergency services for the next thirty (30) business days. I will also provide reasonable refills of your medications for the next thirty (30) business days. This should give you ample time to transfer your care to another physician without disrupting your treatment.
Upon receipt of a properly executed medical records release, my office will transfer your records to the physician of your choosing. You should contact your insurance company or [the local medical society] to obtain information about other physicians to whom you could transfer your care.
Ima Doctor, MD
Mailed Return Receipt on:
Mailed Regular Mail on:
Resolution Is Key
Providing prompt, friendly, and caring service when investigating a patient complaint is the best way to resolve the matter and restore the person’s faith and trust in your practice. In doing so, you will ensure the best possible outcomes for you and your patients. Learning from the experience will enable you to prevent such situations from happening in the first place.
Stephen C. Spain, MD, FAAFP, CPC, has been engaged in the full-time practice of family medicine for over 25 years. In 1998, he founded Doc-U-Chart, a practice management consulting firm specializing in medical documentation. Spain can be reached at email@example.com. He has served on the AAPC National Advisory Board and is a member of the Tyler, Texas, local chapter.