How physicians should deal with angry patients

I highly recommend you take a look at “10 Dumb things you do at the doc’s office.”  Be sure to scan the article, but what you really need to look at is the comments, all 700+ of them.

While by no means a representative sample of how we think about physicians, there is a clear pattern to the comments.  A lot of people feel disrespected by their doctors, and they are pretty angry.

Here’s what patients (including a lot of former patients) had to say.  I attempted to summarize the comments by category and included the top five categories of comments below.

1. Being on time is a two way street. Patients are expected to be on time for their appointments – why aren’t physicians expected to be on time.   Doctor’s think and act as if their time is more valuable than the patient’s time.

2. Listen to what I have to say. “Doctors should realize that many patients have more life experience and have done more research about a condition and drug and may possibly know more than them. God forbid!”  “If you do not like listening to your patients and getting proper information from them, you are in the wrong business.”

3. Don’t just hear one or two of my complaints. “You try telling the doctor all the problems you have and the doctor stops you mid-way, telling you that he or she will take care of two and to come back again for other issues!”  “What about someone like me who is on disability for a multitude of health problems?  What then?”

4. Treat the patient like a sentient human being instead of a lump of potatoes and you will get intelligent patients.

5. Let the patient ask a few questions ok? I’d ask more questions if I wasn’t treated like I was a crazy hypochondriac or an idiot every time I did.

Too be sure there were a handful of supportive patient comments.  Even a few physicians tried to explain themselves, but these folks were quickly shouted down by the mob.

What does it all mean for physicians?  What should physicians do?

Based upon my 20+ years of experience working in health care marketing here’s is what I recommend:

  • Realize that patient satisfaction surveys often do not tell the whole story. That’s because people who are really dissatisfied will not waste the time telling you.   Rather they will go on to tell 10 other people how bad you are.
  • Evaluate these patient comments in the context of your own practice. You alone know if any of these comments consistently apply to your practice.   I doubt very much that these patient comments were coming from patients in physician-patient relationships characterized by strong, trusting physician-patient communications.
  • Most of these comments seem to come out of anger at having been disrespected in some way. I you have patients like this, simply acknowledge that you know this has been a problem in the past, that you are sorry, and will try and do better.  Then really try to improve.
  • Talk to your patients about their experiences in your practice. Just ask patients how you are doing, and then follow-up with meaningful change.   Don’t ask if you really don’t care.
  • Turn lemons into lemonade. The fact is that many patients find themselves in sub-optimal physician-patient relationships.   Given the dismal experience everyone is having, why not strive to stand out from the pack by providing an exceptional experience.   It should be relatively easy.

Steve Wilkins is a former hospital executive and consumer health behavior researcher who blogs at Mind The Gap.

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  • http://hayfeverq.com/ Jeff

    In Re: #2. Listen to what I have to say. “If you do not like listening to your patients and getting proper information from them, you are in the wrong business.”

    Absolutely. I don’t go to the doctor very often, i don’t need to. But when I developed tendonitis in my knees a few years ago (in my early 30s at the time) due to extensive triathlon training I was treated like an out-of-shape whiner. I went to urgent care one day because the pain was so bad and saw a (very) overweight doctor who told me my legs were just ‘weak’. Right, I can bike 100mi or run 15+ at the drop of a hat and they’re just ‘weak’, not to mention squatting 300lbs. I wasn’t amused. I had three similar visits with different doctors and extremely sub-par care before I just gave up and called the best Orthopedic center I could find and made an appointment with a Sports Med knee specialist. Worst case, if a doctor doesn’t know or isn’t qualified to treat your condition, why can’t they just say so and refer you?

    • http://www.facebook.com/profile.php?id=596695443 Heather Jacoby

      YES. There is no shame in a referral! I find that when some doctors feel uncomfortable, they start giving you diagnoses like “anxiety” or “depression.” My doc gave me a depression diagnosis and then at my next visit wrote that I have “generalized anxiety.” I asked why and his answer: “Oh, anxiety, depression. Same thing!”

      LOL. 

      I have a new doctor. :)  

  • http://www.howtobesick.com Toni Bernhard

    Thanks so much for summarizing the comments that were made on the “10 Dumb Things…” piece and then using them to give some excellent advice to doctors. I’ve been chronically ill for ten years and have seen many specialists. I’ve received a range of responses, from being disregarded to being respected and appreciated for the knowledge I have about my own illness.

    I’ve written a book called “How to Be Sick: A Buddhist-Inspired Guide for the Chronically Ill and their Caregivers” in which I talk about the range of experiences patients are likely to have and how they can learn to respond skillfully when a doctor doesn’t live up to their expectations.

    Thanks for your work on this piece.

    Toni Bernhard
    http://www.howtobesick.com

  • Sarah

    I think my favorite thing my pcp does is she explains each of my prescriptions thoroughly to me while prescribing. She’ll tell me how it works in the body, side effects, etc. all in terms I can understand!

    • http://www.facebook.com/profile.php?id=596695443 Heather Jacoby

      I like that my doctor doesn’t balk whenever I say something like a “bronchiospasm.” 

      My pediatrician taught me certain concepts about my asthma when I was in elementary school so that I would know what was happening in my body to make me sick. I learned about allergens then, too. He made me into an informed patient. I see a lot of asthma patients who don’t even know when they need to use their rescue inhalers, or who think asthma and allergies are the same thing. These are people who are more likely to end up at the ER than someone who keeps a calm head, uses medications appropriately and gets an appointment with the doctor when symptoms escalate despite the medicines. 

      I had one doctor who I had to “play dumb with” because he would have an issue with me using words that only HE was allowed to use. I can describe what I’m talking about by saying “bronchiospasm” or I can spend 10 words trying to give a subjective description of something I’ve known I’ve had since I was a child.

  • cd

    Sorry to say that points 1 and 3 are mutually exclusive. You can’t run to time if everyone comes through the door with 5 or 6 problems, in the uk family doctors have 10 minutes per patient!

    • http://www.dialdoctors.com Dial Doctors

      Doctors can listen to complaints and be efficient. It’s best to ask patients to be honest and upfront in the first couple of minutes. If the doctor has a clear list of what’s going on then he can quickly plan the best way to manage the time left.

      Some complaints are full-fledged problems that may be even more important than the original reason for a consult.

      It may be difficult at first but it can be done. It requires changing how we used to do consults

  • Kristin

    From what I understand, the reason doctors ask patients to come back for another appointment for multiple symptoms is the reimbursement structure. If my PCP sees me today for my viral infection and also for a rash, she gets paid for one issue; if she sees me today for the infection and next week for the rash, she gets paid for both issues. This raises her cost of providing care if she’s a soft touch and deals with both issues today, probably taking more than the budgeted 10-15 minutes; it raises my cost of receiving care if I come back next week, taking more time off work and using more transportation. Somebody gets screwed either way.

    It sucks pretty hard. That reimbursement system needs to be reworked.

  • JPB

    No one has touched on the problem of docs ‘looking’ for problems in an aysmptomatic patient. I finally stopped gong to the doctor when I realized that they were basicaly on a fishing expedition!
    (And I don’t agree that docs are not being paid enough. According to Forbes in 2009, primary care docs were paid a median $190.000+ and that is after expenses. That is more than 4 times the average American’s income.) Where do we go from here, I have no idea but I’m not making any appointments soon!

    • Kevin

      Taking a complete ROS (Review of Symptoms) is just good medicine. Your doctor isn’t “fishing,” he/she is practicing good medicine.

    • Anonymous

      I just want to remind you that PCP may get paid 4 times the average american income, But they work more than 4 times the hours and endure more stress than the average american. They pay more taxes and they get sued more often than the average american.  They only get paid when they see you for a visit but they are on call for the hospital when you show up in the emergency room, they refill your meds when you call your pharmacy to renew it, and they fill your disability papers, social security papers, prior authorizations for medications and procedures from your insurance company, they bill the insurance company for you so you don’t have to pay upfront. they often send many letter to try to collect the co pay and patient share of cost. remember also review your labs and xray as well as reading the consultation reports to keep up with you medical care. In the spare time they have they read the new studies, research and medical literature to keep up to date so you get treated right. They have to continue to study and be tested by the medical board of their specialty to keep board certified.  and so many more tasks. Believe me they are underpaid.

  • Joe

    1 and 2-5 are not compatible, at least not in a traditional practice setting. i’m reminded of the saying which goes something like “fast, cheap, good – you can only ever pick 2″. there are types of practice in which all of those complaints are readily addressed – concierge, retainer, cash only, etc.

  • solo fp

    I have my front desk screen potential new patients. I got tired of new patients coming in from other practices bad mouthing the previous docs. I find that choosing pleasant patients ahead of time saves a lot of time in the future not having to transfer records. Outside of the patient who moves out of the area, I transfer fewer than 10 patient records a year. I also do not accept chronic narcotic patients or patients with 10+ concerns that often are related to having med lists of 20-30 meds from 7 or more specialists. You have more time to listen and ask questions with the straightforward patients.

    • e-patient

      There is all this talk about the incentives that will cause doctors to cherry-pick patients. It seems to me that doctors already cherry-pick patients as noted above. While I don’t quite fit the profile of those you screen out of your practice, my health is too complicated for someone who only want to care for the easy patients. I have already been discarded because my health issues are too difficult to deal with in a 15 minute appointment. All the warning about the decline of family medicine doesn’t really concern me. I am not in a category of patient that gets quality care. The cherry-picking has already happened and I have been left to rot in the bottom of the barrel.

    • http://www.facebook.com/profile.php?id=596695443 Heather Jacoby

      Solo fp. I hope I never encounter you. I didn’t ASK to be sick. If all doctors did what you do, there would be a lot of people who need and deserve care who would be turned away. 

  • Dyck Dewid

    Thanks from a mere human.

    I expect those doctors who read and engage here, and w this topic, are not the one’s targeted… who also may need to be shaken or booted out of the ‘care’ field of patient-contact medicine. So, it seems a false sense of comfort I have to read about others who know what I know and feel what I feel. But, nonetheless, I like to see it. Thanks

  • Sandy

    I understand the pressures of a 10-15 minute appointment window so, between appointments, I keep a list of questions or issues as they come up (on my master medical history document), prioritize it before my appointment and hand it to my pcp once he settles in and asks “whats new?”. That way we can focus and make the most of our time together. Then, when I come home, I annotate that list with what we decided and move any items not addressed to the next appointment section. I know he cares about me even though I’m 64, obese and read a lot of medical information and can ask questions about issues relating to my health. I truly feel like we are partners despite the pressures my insurance company places on him.

  • Kendra Pettengill

    I think patients are more demanding and hence angry at bad care or the lack of compassionate care because of the changes in insurance coverage. Insurance in America as we once knew it has disappeared. So every time someone makes an appointment with or without insurance it mostly is becoming an out-of-pocket expense with HSAs etc. being forced on people unable to build up enough to help with expenses. So even with insurance it is like being uninsured for many, and that means people demand that every appointment be productive, good communication, and end in a resolution of some type. It changes everything when every visit comes entirely out of my pocket, while I still pay huge amounts for worthless insurance. It will not get better, only worse and people are going to demand better care. If I feel a visit has wasted my money because the doctor was inattentive, blew off what I said, or disrespected me, I am going to be very angry and go elsewhere. After all, the patient is a paying customer, and I think many in the medical field have forgotten that.

  • http://pulse.yahoo.com/_7NWSFIL3COMMGYZDBHO44SZSOE G Meyer

    There is a dilemma here.  Patient want us to be on time on appoitnements, yet they want us to listen to call complaints at one office visit.  Unfortunately one or the either can be done but not both.  To stay on time, visits need to be kept short to a 10-15 minute slot.  If we listen to multiple concerns, that puts us behind for other patients and so on. 
    There is no quick fix to this problem

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