No matter what type of specialty you practice, a strong and healthy therapeutic relationship is essential to gaining patient trust and compliance, hence leading to positive health outcomes for your patients. Nonetheless, there are many days when due to unpleasant doctor-patient interactions and rude patients, the workday may feel like a struggle and drain our energy and enthusiasm. Unfortunately, this scenario is not uncommon and can sometimes feel like the norm. According to the American Academy of Family Physicians, https://www.aafp.org/PUBS/FPM/issues as many as 15% of patient physician encounters are rated difficult by the treating Physician.
As it turns out, many patients have also come to feel their healthcare provider is not showing the expected kindness, caring, and courtesy they once enjoyed. Patients go to their doctors wanting to be heard and expect their doctor to understand their particular situation. According to statistics put forth by United Healthcare, most doctors only listen to their patients for 11 seconds before interrupting them. Many times, patients receiving their diagnosis, feel anxious because they perceive they have little or no control over their care plan. They also feel that at the end of the visit, they have not understood their diagnosis, often reporting that their healthcare provider explained the diagnosis and plan too fast. Virtual healthcare can also make patients feel helpless and scared, because often patients will receive their test results through their patient portal before a provider can review their significance with them.
First Impressions Count
According to the AAFP, http://www.aafp.org./PUBS/FPM/issues/2017/0900, an otherwise pleasant patient may behave rudely and become angry by the time they see a physician due to how they are treated by front office reception staff.
They may become annoyed because the waiting room is too cluttered or noisy. Patients may be short with their provider because of having to wait in exam rooms that may be too cold or too hot. They may feel overly nervous due to language or literacy concerns. Therefore, it is crucial to review important points of contact within the practice and anticipate any possible environmental factors that may make patients feel uneasy and affect the therapeutic experience.
The Types of Difficult and Rude Patients
While all difficult patients can make getting through the day an arduous task, they are not problematic for the same reasons. There are many facets that can contribute to the patient becoming rude, pushy, and even potentially aggressive and violent.
So, Who Are the Players??
The Manipulative Patient
They may threaten legal action if they do not get their way. Some will bribe or threaten their physician with good or bad reviews based on getting what they want. They may even threaten to harm themselves. They tend to struggle with personality disorders. The key here is to remember that they are actually playing on your emotions.
Therefore, it is important to keep calm and remain self-aware when dealing with these types of patients. Often written forms that patients can read and sign may set healthy boundaries and establish expectations in writing.
These patients are known to everyone in the office or clinic due to their frequent visits. These patients, although no more or less important than others, will take up multiple appointment slots to discuss medication questions, or to consult on occasional symptoms, or to find out if the medical information they were given by other healthcare providers, or their friends and family is correct. They likely suffer from anxiety or loneliness or both and may have somatization disorder.
The Somatizing Patient
As mentioned above, they can require multiple visits, calls, or emails to address an ongoing array of vague signs and symptoms. They have likely seen several other physicians in multiple settings and report having “fired” them because the urgent care, emergency room, and other primary care providers they consulted did not agree with them and did not take them seriously.
The key to maintaining a therapeutic relationship with these rude patients comprise of the three C’s: a) compassion, b) a calm demeanor on the part of the healthcare provider, and above all c) a caring attitude that addresses their concerns.
It may be helpful to set up regularly scheduled visits and address concerns that will inevitably arise. Confronting patients with a dismissive attitude and telling them not to worry or it is all in their head never works.
The Angry or Defensive Patient
There are, definitely, a variety of factors that may contribute to making a patient angry or defensive. They may be angry about waiting too long to be seen, or perhaps with a friend or a co-worker prior to their visit. Anything may have gone wrong in their day, and they lack the emotional maturity to remain courteous to you or your staff. They may feel they have been mistreated over the phone or by the front desk staff. But, whichever the cause, you can become the person they direct their anger toward.
The good news is in most instances there are many ways to address the situation, and hopefully steer the visit toward a satisfactory outcome. There are ways in which to respond to such patients that can calm them and help staff and physicians maintain an optimistic and resilient attitude as they continue their work. Keep in mind that even though you are their preferred target for the moment, you may not be doing anything wrong.
The Non-Compliant Patient
These rude patients tend to suffer chronic diseases, such as hypertension, heart disease, diabetes mellitus, hyperlipidemia, etc. You may spend many visits listening to them, educating them, and motivating them. Your staff may spend time and effort working on prior authorizations to help these patients avoid high co-pays. Your staff may even spend hours on authorizing multiple specialty referrals. All of this, only to find out on a follow up visit that they have not even picked up the much-needed medications and have not followed up with the appropriate specialists that should have been an integral part of their medical care.
They will cancel and will no-show for many appointments, arrive late, and go as far as to claim no one told them their prescription was ready or their imaging order was authorized. These patients typically claim they have “lost” the mammogram order, the x-ray order, or their lab order, and hence have not completed their needed studies. They may place blame and responsibility on their medical provider and office staff. All of this can be very frustrating and lead to multiple duplicative work.
Unfortunately, there is no medical practice that is spared. The key is to remain aware and avoid becoming emotionally involved in the outcome when it comes to the non-compliant patient. Instead, employ multiple automated reminders and document when the patient has been informed about their care plan. Utilizing email, text reminders, handouts, visit, summaries, and other forms of communication can really help. Remain calm and be ready when the patient decides to face their illness and take responsibility for their health.
How to Create a Therapeutic and Respectful Alliance with Patients
The above-described patients can sometimes baffle the most seasoned physician. Therefore, it is best to always refer to the code of medical ethics. Below is the list put forth by the American medical association. https://code-medical-ethics.ama-assn.org/ethics-opinions/patient-rights.
Physicians must serve as patients advocates and represent patients’ rights which include:
- The right to courtesy, respect, dignity, and timely responsive attention to his or her needs.
- To receive information from their physicians and to have an opportunity to discuss the benefits, risks, and costs of appropriate treatment alternatives, including risks, benefits, and costs of foregoing treatment. Patients should be able to expect that their physician will provide guidance about what they consider the optimal course of action for the patient based on the physicians’ objective professional judgment.
- To ask about their health status or recommended treatment when they do not fully understand what has been described and to have their questions answered.
- To make decisions about the care the physician recommends and to have those decisions respected. A patient who has decision making capacity may accept or refuse any recommended medical intervention.
- To have the physician and other staff, respect the patient privacy and confidentiality.
- To obtain copies or summaries of their medical records.
- To obtain a second opinion.
- To be advised of any conflict of interest their physician may have in respect to the care.
- Patients should have the right to continuity of care and should be able to expect that their physician will cooperate in coordinating medically indicated care with other healthcare professionals and that the physician will not discontinue treating them when further treatment is medically indicated without giving them sufficient notice and reasonable assistance in making alternative arrangements for care.
The Last Resort
There will be times that the inevitable may happen despite all the effort put forth to maintain a mutually respectable and therapeutic relationship.
In such situations, maintaining a courteous and professional demeanor and remaining calm without allowing patients to trigger any inappropriate behavior on your part is crucial.
It is best to inform the rude patient that you will be discharging them from the practice in person with an office manager present. Additionally, informing patients in writing that you will be discharging them from the practice is mandatory. Let them know that you care about their health and will be available for a period of 30 days for any emergencies that pertain to their care plan until they find a new medical provider to care for their needs.
At times, the most therapeutic decision can involve discharging the rude patient from the practice to allow them to seek care with an alternative medical provider that the patient may prefer over you.
In the end, knowing how to respond to each patient and trying to deliver personalized care with an understanding and compassionate attitude can go a long way in preventing a break in the therapeutic bond.
It is important to keep in mind that discharging a rude patient does not reflect on your ability to deliver excellent medical care.
As the saying goes, there are times that patients make us feel contented and happy when we see them in our offices and there are times that we feel equally happy when they depart from our office.
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