Those 'Difficult' Patients Whom You and Your Staff Dread

Mark Crane

Disclosures

December 04, 2014

In This Article

Apologies Can Win Over Difficult Patients

Saying you're sorry because the patient had to wait 40 minutes past his appointment time is just respectful and diffuses anger.

"When the patient is angry, we apologize even when we're not at fault," said Patricia Roy. "Waited too long? Apologize. Hated the specialist I referred them to? Apologize. Not happy with the outcome of a test, treatment, etc.? Apologize. Patients are forgiving if you are seen as genuinely sorry for what happened to them, regardless of how it happened. You are an ally, not an enemy.

"Then the most important part is to offer to help correct the problem. Suggest ways they can deal with the bills or side effects. Offer to call the specialist. It's amazing how often patients just want to vent. Once they know that you're on their side, they're satisfied," said Roy.

There's an art to making an effective apology. "You have to be specific about the situation," said Gerald Hickson. Bad apologies are, 'I'm sorry, but...' or 'I'm sorry you feel that way.' That can be irritating and trivialize the patient's concerns. If an apology is appropriate, make one and be specific. If an apology isn't appropriate, avoid blaming others or the 'system.'"

Many doctors are reluctant to apologize because they fear it can be used as an admission of liability in a malpractice suit. That fear is overblown. Some 36 states now have apology laws that prohibit certain statements, expressions, or other evidence related to disclosure from being admissible in a lawsuit, said Doug Wojcieszak of the Sorry Works! program, which encourages greater disclosure.

Are Some Doctors Part of the Problem?

"There's a bell-shaped curve of difficult patients," says Hickson. "Some have personality disorders. Others are drug seekers. But most are frustrated by what they see as a lack of respect by the doctor and his staff, or they use anger to mask a fear that something is seriously wrong with them."

"If we doctors had more time, difficult patients would become a lot less difficult," says Joseph Scherger. "The truth is, patients ask a lot of questions doctors don't want to hear. Difficult patients may just be smart consumers who want to receive better explanations for what you're recommending.

"Physicians usually interrupt patients within 30 seconds of the start of the visit," he said. "We even teach residents to interrupt to 'control the conversation' and 'limit the agenda.' That creates conflict and is bad medicine. It doesn't take that long to let the patient tell his story."

"It's amazing how much pressure and tension leaves the room once they get it all out," Scherger said. "By letting them finish, you can learn what the patient is actually worried about and he'll be more receptive to hearing our recommendations."

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