Staying calm when a patient's behavior is out of line

October 1, 2008

The typical difficult patient can ruin a perfectly good day at your practice if you let them. By not taking it personally and keeping your cool you can successfully deal with this type of patient without adding stress and frustration for you or the patient.

Key Points

Northbrook, IL-How many times has this happened to you? You are having a great day at the practice. The doctor has seen a record number of patients and all of the patient visits have gone smoothly. You are on top of the world and you love your job.

When you look up, standing before you is a patient who appears angry or upset.

He or she is your stereotypical difficult patient. Every practice has them. He or she may want to complain about a recent bill or about how long he or she had to wait. The patient may need to schedule a follow-up exam but can't make up his or her mind about an appointment date or time. He or she may want to tell you what is wrong with him or her. Or the patient may just be a rude person.

"Your actions speak louder than your words," Weinstock said, "but your words say a lot as well. So it's important to know what you're saying and what you're doing and how you respond to them."

Weinstock, a specialist with Office Management Solution, Northbrook, IL, offers practical advice for physicians, practice managers, and office personnel to improve communication between staff and patients, diffuse difficult patient situations, and deal with patient conflicts.

"Whatever you do, don't take what's happening in your office, and what your patients are doing, personally," she said. "Focus on what needs to be done and what you can do to resolve a situation."

Signs of a difficult patient

Weinstock identified the most common types of difficult patients, which she labeled the complainer; the silent and unresponsive; the hostile; the negative; the indecisive; the know-it-all, and the rude. At one time or another, you have probably encountered each of these as well as others in your practice.

"Handling difficult situations in a professional way will turn difficult situations into positive outcomes," she said.

One of the major steps that will lead you toward a positive outcome is understanding your patients. According to Weinstock, you have to think "like a patient."

First of all, patients are more knowledgeable than you think. "Didn't they look it up on the internet?" Weinstock asked. "And didn't their friend tell them? After all, their friend had the same thing happen and it's got to be the same diagnosis." She told the story of a patient who walked into an ophthalmologist's office with charts and notebooks and supporting research, convinced he had macular degeneration. The staff member calmly told him, "It was nice of you to come for a second opinion." A potentially difficult situation with a know-it-all patient was defused with a bit of light humor.

Secondly, patients face more out-of-pocket medical expenses as the industry's reimbursement rates continue to decline. Weinstock gave an example: "I just called the insurance company," she said as a patient. "They're not paying it because you didn't submit it right." You know your billing department submitted the claim correctly, so the ball is in the insurance carrier's court. But try explaining that to an irate patient glaring at you in the middle of the office.

Patients also value their own time more than yours. Patients are busy or in a hurry and they don't want to wait. How often has a patient's cell phone gone off during an appointment?

Finally, you must consider the personalities of your staff and your patients in combination, Weinstock said. Why does a certain member of your staff, who gets along with everyone, have trouble with one patient? It may simply be a personality clash. In this case, asking another staff member to assist with that patient may resolve a potentially difficult situation.

Stress is significant, she pointed out. A patient may be expecting, or may have just received, bad news from the doctor. If the patient is in pain or has a vision problem-let's face it, in a majority of cases patients are in your office because they have vision problems-they are more likely to be irritable from the start.

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