Safeguarding the Physician-Patient Relationship Starts from Within (Your Practice)


By: Nan Gallagher, Esq.

Some Patients Can Be Difficult. That’s a Reality.

With consumerism a trend in healthcare, patients have free rein in rating physicians. They even have the right to fire them. But what if the shoe were on the other foot? What if doctors rated patients and identified some as difficult, finding that the customer (e.g., a patient) wasn’t always right?

First off, how would a patient earn that label? Would they be more than occasionally late? Mistrustful, angry, non-compliant, or unpleasant to your staff? A person who never finds value in the care you provide and does not follow your medical advice? Any of these could fall under this category. The important question is … how do you and your medical team manage these contentious relationships? Should you try to resolve issues? Or, outlandish as the idea may seem, should you discharge these difficult patients? There is considerable latitude between the two extremes.  Neither should be treated lightly.

Could YOU Have Done Anything Better?

Best practice calls out your first step as reconciling—or trying to—reconcile thorny issues. Managing relationships with difficult patients is a sequential process, which means that the first step starts with assessing your staff’s and your own actions as well as your overall practice management processes. What went well? What didn’t? What could we have done better?

An honest assessment flags any inappropriate action or behavior and establishes remedial actions that will help build your practice long-term.

Your policy manual is the first point of contact for the tough spots. It should include written procedures for office protocols, including procedures for managing challenging patient situations and all the systems necessary to run a successful practice. A policy manual makes clear what great customer service in a medical practice looks like.

If you have not created one, you will be left guessing at what will or won’t work to accommodate and exceed your patients’ medical needs.  A policy manual also can set the standard for the functions of the all-important front desk staff. Front desk customer service (by phone or in person) is part of compassionate patient care. Fail here, and you are likely to lose patients or end up with them feeling angry and acting out their annoyance and/or anger during your exam. In fact, according to the American Medical Association, a patient dissatisfied with services rendered by a medical office’s front desk personnel is 66% more likely to never return to the practice, to write a grievance online or to a state licensing agency, or to tell a friend.

Red Flags and Good Listening

More than three bad online reviews, complaints raised to your attention, or your observation of overly social or texting behaviors at the front desk are the red flags that say a bad patient is linked to poor customer service by your practice team.  What’s more, you, too, need to take a look in the mirror.

One of the best ways to start your self-assessment is to evaluate your listening skills. For example, you may feel the need to get to the point of the visit more quickly than a patient who is providing a great deal of detail and backstory.  In striving to move things along, you may interrupt, a tack the patient may find rude, when empathy and acknowledgement may be more appropriate handling.  Balanced against this is that more and more insurance payors do not compensate you for spending more than a mere few minutes with your patients.

Sometimes, too, the unavoidable creates situations that cause an angry patient-physician encounter. Perhaps you have had a patient emergency that delayed you an hour. While the situation was beyond your control, understandably the patient is agitated. Long waits breed angry patients. A sincere apology is a preferable approach to a defensive stance.

Triggers and Personal Baggage Create Potential Problems

There are also your triggers. We all come to our offices some days with our own “baggage.” Occasionally, maybe we are tired, overworked, or stressed about our businesses or even things going on at home. That is human. Still, your goal must be to leave your own irritations outside the exam room. Consistent irritability, condescension, or rudeness can also be the result of

burnout or moral injury, a condition with which many physicians suffer these days and one that must be compassionately addressed.

When All Else Fails

No one likes to leave a situation without resolve. Occasionally, however, you may face irreconcilable differences with a patient. While in most cases, you can discharge a patient from your medical practice for any legitimate and nondiscriminatory reason within the guidelines of your licensing board, it is important that you proceed in a patient-first manner. Because healthcare is a highly regulated industry, it is imperative that you take appropriate counsel from your healthcare attorney. You must also employ the necessary safeguards and protocols to ensure that the separation is legally proper and in no way endangers the patient’s well-being and health.

First, you must be sure that discharge is actually within your rights. Some managed care contracts limit a physician’s ability to terminate doctor-patient relationships. Others are very specific as to protocol and the written form that should be used to discharge patients. Even if a plan notifies a patient of the terminated relationship, you must also send a letter to advise that patient of the managed care organization’s plan to reassign the patient.

Second, alternately, despite the latitude you may have to terminate a relationship with your patient, you must provide the proper notice. Above all, you must not withdraw from caring for a patient who is in the middle of a medical crisis. What’s more, a decision to terminate a patient is your decision, not your medical staff’s. That said, your staff should be informed of every step of the termination process to make certain no additional appointments will be scheduled.

There is no silver bullet that can ensure that you will avoid difficult patient-doctor encounters. Your first tack is to make certain you and the members of your practice team have performed appropriately so as to avoid reproach. Keeping things on track is your responsibility including having a policy manual and assessing your own and your staff’s behaviors to make sure you are welcoming patients to your practice and the exam room. Using these resources and adopting these guidelines will position you to deal with trying situations and result in a successful experience for your patients as well as for you and your staff.

At The Nan Gallagher Law Group, we are here to provide guidance on every step of your journey.

Call us at 973.998.8494 and let us help you in situations that take you out of your comfort zone and those that are part of your everyday operations.