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Live Blog: Dealing with Angry or Difficult Patients – Joe Monroe, PA-C

In this live blog from the 12th Annual SDPA conference in Indianapolis, Joe Monroe, PA-C shared his pearls about “Dealing with Angry or Difficult Patients.” Here are some of his highlights. 

Nobody likes surprises. It’s often when our patients are confronted with “surprises” that they become frustrated or angry. Have you experienced a patient who expects you to do what their referring doctor “said” you would do. (“My ‘real doctor’ said you’d just scrape this off!”) When you, as the specialist, recommend something else, or if you want to do a consult first, the patient will often react (and sometimes act out) in surprise.

Or perhaps your patient expects to receive “that one drug” their friend got from a different dermatologist. You may not want to prescribe that drug for their problem and then the patient perceives this as an issue. What do we do when we face difficult patients? How do we treat our patients with respect, resolve the problem and keep our sanity? 

Most problems can be resolved!  Here’s a step by step that Mr. Monroe presented:

1. Demonstrate Belief

Get down on their level. Make eye contact and listen to their reason instead of starting off by defending and arguing your side. When you let them have their say, you save time in the long run. 

2. Zero in on the Patient’s Feelings

You can touch them on the knee, shoulder, or hand, letting them know that you are tracking with them. Use non-verbal communication.

3. Restate the Problem

“If I understand you correctly, you’re upset because you expected…”  It may take several cycles of this to clarify the situation

4. Apologize

Own it if it is your fault, and if it wasn’t your fault, express regret over the situation. “We didn’t expect it to turn out this way and I understand how that feels like a let-down.”

5. Don’t Dazzle with Knowledge

            Patients don’t care how much you know until they know how much you care.

6. If You Don’t Care, You May be the Problem

This is one of the first signs of burnout and can often be a part of the problem.  Trade places with the patient who is seeing a provider who would rather be elsewhere.

7. Offer a Choice

Offer the patient possible choices and allow them to choose.  When possible, end with a contract: “If I…, will you…?”

With high-maintenance patients, schedule regular visits that you can control. Call them to check-in, don’t wait for them to call you. And with these patients, remember to keep your promises.

According to Monroe, when the differences are irreconcilable, the next step may be to fire the patient. Be sure to have them terminated from the whole practice, not just from you, and note that this course of action most likely means firing the whole family.

Ending the patient/provider relationship occurs for a number of reasons including treatment or follow-up non-compliance, verbal abuse, or non-payment. Monroe stressed that, in the case of verbal abuse, it will make an impact if the patient is asked first to apologize to the front and back office staff. These members of the office deserve to be protected and respected.

Termination letters are the best and legal way to go about the termination. The letter should be sent by regular and certified mail with a return receipt requested and copies retained for practice records. In this letter, spell out what you’re doing, include alternative clinics for treatment, and offer medical record transfer. You are not required to tell them why you are terminating. Remind the patient that as of the termination date, care is not in your responsibility and that refills will no longer be provided past this date. If the patient decides to ignore the call for termination, listen to their complaints, restate their complaints, suggest solutions, and keep in touch.

Monroe also presented some upsides to terminating a relationship with a patient. Some “silver linings” are that the patient can leave to find the type of provider they want, your staff will feel supported, and some patients will see that you take the steps to insure you protect your staff and want patients to find the provider they desire.

Image: Na’dir