10 ways doctors can lose their patients

As a neuropsychologist, I have the chance to talk to patients throughout the week in detail about their medical histories, supplemented by a comprehensive medical records review. Part of this involves discussing which provider the patient has seen and if the provider was changed, why. Sometimes, a provider is changed for a benign reason, such as a move or an insurance change but other times there are significant complaints. Granted, there are always two sides to every story but when I consistently hear the same or similar story from different patients year after year, the stories gain credibility.

Then, when I start to notice the same problems during my own doctor visits, I know there are some serious problems that can be fixed. So, listed below are my top 10 ways for doctors to lose patients from their practice. If you have others to add to the list, please do so.

10. Not accepting lists of symptoms or timelines from patients. If you see patients, you know they range on a continuum from poor historians who have no idea why they are there to see you and those who arrive with carefully constructed histories that they are eager to give you as soon as you walk in. Just about the worst thing you can do when this happens is to tell the patient that you don’t want the list and do not even want to look at it. That connotes a dismissive attitude to the patient and it makes them feel like all of their work was for nothing – work that was done in the hopes it would help you figure out what was wrong. You may have very good reason at the time not to look at the list such as time pressure, but at least take the list and say you will later take a look at it. It will likely provide you some useful information.

9. Asking patients to choose what type of medication they want to take. When a patient has a medical condition in need of medical treatment, the physician is looked to provide their advice as to what medication to take. They don’t want to be given a list of three possible medications, told to research them at home, and come back with a decision. From a patient’s perspective, this is why the doctor went to medical school, not me.

8. Long wait times and no apology and/or rushing the patient once coming in. While no patients want to wait long, they will generally accept the wait time if they are pleased with the care you provide, or if it the initial visit, know that you have a good reputation. However, if the patient waits long and you then walk in and do not acknowledge the wait, explain why there was a wait, and apologize for the wait, it will significantly aggravate the patient. Rush the patient after a long wait and no apology and it will worsen the situation further.

7. Poor bedside manner. This is an easy one and has been addressed extensively by others, but don’t do things such as repeatedly looking at the clock, repeatedly interrupting patients, focusing more on you than the patient, talking rudely, making poor eye contact, etc. Follow the Golden Rule and you will easily establish rapport the majority of the time.

6. Not being responsive to challenging questions. Provided that a patient is being respectful, there is no reason to become upset when a patient asks questions challenging a diagnosis or course of treatment. Most patients are generally accepting of your expertise but they may have heard or read something that has given them legitimate questions. Your answers can help reassure the patient that your diagnosis and treatment is correct. Patients are also usually more impressed when you tell them you have no problem with them seeking a second opinion rather than demanding they only accept one point of view and/or becoming overly defensive. Also, patients (or families) sometimes come up with questions that can lead you to entertain an idea you did not previously think of that can improve care. Don’t shy away from this. Embrace it.

5. Disrespectful staff. While the patient may like the care you provide, there are a host of other people they need to interact with before and after the appointment. This includes the receptionist, billing staff, nurses, and others. If these individuals are rude and disrespectful, the patient will likely switch to another provider whose friends and family say have better ancillary staff. It is like owning a restaurant with good food but a terrible hostess and waitress. Many people will just choose a different restaurant. Train your staff to treat your patients they way they would want to be treated (and teach them how to manage patients who are rude) and you will have a happy client base.

4. Drab and dreary office space. No one likes to go to the doctor. Take some time to make it a more enjoyable experience. Have comfortable seats in the waiting area and waiting room, put some nice art up on the walls (geared towards children if it is a pediatric office), have a TV on with cable (with cartoon options for children), soft music, etc. Whether right or wrong, offices that are bare, uncomfortable, and cold looking convey a message that the patient perspective is not being considered.

3. Being unavailable when needed during routine business hours. When the answering service repeatedly picks up the phone during normal business hours, it is extremely frustrating for patients. Same with staff not returning phone calls or being absent for 1.5 hours during lunch time. Patients need to have access to staff during normal office hours to make appointments and ask questions.

2. Cancelling/rescheduling appointments too often. Patients are understanding when a doctor needs to cancel or reschedule but not if it happens too often. This was highlighted in the recent trial of Dr. Conrad Murray, whose former patient testified that after two follow-up appointments were cancelled he felt that the doctor blew him off. The patient never followed up with Dr. Murray again.

1. Making decisions that cause patient harm that were easily avoidable. While patients will sometimes give doctors a second chance, they won’t be inclined to do this if harm occurred to the patient or a family member that could have easily been avoidable. This is especially true if the harm happened to a child. As a personal example, I recall repeatedly explaining to my pediatrician that my child’s cough and wheezing was persistent and affecting her breathing, only to be repeatedly told that it was only allergies, despite the fact that she was cleared by an allergist and was not improving with allergy medications or a nebulizer. Finally, and only by pressuring the physician to do more, was a chest x-ray ordered. Diagnosis: double pneumonia and a week long hospital stay. Totally avoidable. The new pediatrician is very responsive and we have been very pleased for many years.

Dominic A. Carone is a neuropsychologist who blogs at MedFriendly.com.

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  • Andrea Duran

    Good article —  (as a patient, I have dealt with just about every one of the issues listed, often in the same practice!) but I have one minor disagreement with #4.  There seems to be a trend in doctor’s offices to have a TV in the reception area, and in nearly every office I have visited, the TV has been turned to Fox News.  I am stressed out enough in the doctor’s reception area as it is, and to have to listen to a bunch of talking heads chatter incessantly is beyond annoying, particularly if the reception area is small.  I would far rather have soft music playing in the background (I’m told the TV/music is really provided to interfer with patients overhearing what is being said at the front desk.) 

    • Anonymous

      How lucky you are, My doctors office routinely has MSNBC on.  I use to have a Casio watch with a remote control on it.  That was really nice, I could change the channel without any one knowing I did it.

    • Payne Hertz

      I have to laugh at this one. I was just about to write about this very subject when you beat me to it. I’ve also found pretty much every doctor’s office where there is a tv has it tuned to Fox News. That’s especially true at the VA unless someone has the decency to change the channel to something worthwhile, like Barney the Dinosaur. The fact my doctor would even countenance having that bilge playing in his office is a huge turn off and will likely send me looking for someone with a less fascist perspective.

  • http://twitter.com/katellington Katherine Ellington

    It’s deeply troubling that there are not any independent bodies where patients and staff can express their concerns without fear. Clinicians and practice settings have to know that the quality of the patient-physician relationship saves costs as well as lives.  Poor bedside manners and professional behaviors abound especially among vulnerable populations where silence and inequality do real harm.

  • http://pulse.yahoo.com/_AQGAJ4XQOZ56VG4GULIC324QCQ That really cool Sarah

    I’ll add one:  I dropped a physician when I was sent to a crummy lab for bloodwork, where the wait was interminable and my company sketchy/loud and the receptionist wrangled at high volume and snippy tone with patients about payment.

    Then, four weeks later, instead of a list of my lab values, the physician’s office clerk sent me a note in a loopy, girlish hand that my “results were negative”  (Heart). 

    I want my labwork results!  ( Last time I had “negative” lab results they weren’t really. )

  • David Hanson

    I don’t agree with number 9.  I would like to choose from a number of alternatives and also choose whether to take any medication or not.  When a medication was prescribed for DW last year, the doctor took 10 minutes explaining the normal lack of side effects and why she needed the medication (he took the time because he knew we were skeptical about any medications).  Then we researched the medication on the Internet and when we were fully informed then DW only agreed to a trial period to see if the medication helped.

  • Anonymous

    I dropped one of my favorite doctors of 20 years because of his receptionist staff.  Calls on hold for 10 plus minutes, snippy, impatient, made you feel like an annoyance.  I had a knot in my stomach every time I dealt with them.  I was afraid to complain to the doctor about this, so just disappeared from his care.

    • http://twitter.com/RamonLizardoMD Ramon R. Lizardo

      As a Dr……be a great friend/patient of 20 years. Do call him, and tell him specifically. You would’t imagine how much we appreciate when an tenure patient is honest!

  • http://twitter.com/RamonLizardoMD Ramon R. Lizardo

    A few good reasons.

  • http://warmsocks.wordpress.com/ WarmSocks

    Re #4:  while it’s true that ambiance is important, I’d agree with the others who say “no” to television.  I’d much rather have some classical music playing in the background.

  • http://makethislookawesome.blogspot.com/ PamC

    Brilliant. If all my doctors followed this, I wouldn’t have a single complaint.

  • Ruth Ann Artz

    We now travel over 50 miles to our MD. We went to the same MD for 15 years, never sick, never really needing care. Then, everything changed.
    Our son was killed in a car crash. We couldn’t eat or sleep. I called the MD 3 times asking for anything to help us take the edge off our incredible grief. They did not return my calls. One day I received a bill for an office visit with a handwritten note “sorry about your son.”
    My mother died six weeks later, my husband was impacted in a mass lay off and the stress caused me to become ill.
    I was sure it was my gallbladder. My MD was not sure, first because I did not have “classic” symptoms” and second, the ultrasound did not indicate stones. After begging the MD to let me have a nuclear scan it became apparent my gallbladder was not functional.
    The radiologist read the scan that afternoon; however, it took 5 phone calls to get my MD to address my non functional gallbladder.  I became so ill, I couldn’t walk. Finally, the MD called with the results, stating “I have never seen anything like this. I think you have cancer.” Plan of treatment: An endoscopy.
    At that point,  I called a teaching hospital and begged to be seen by a surgeon there. The surgeon took one look at the scan and had me in surgery in two days. She found a leaking, gangrenous gallbladder and a gangrenous umbilical hernia. She stated I was literally days away from death and if I had been scoped, perforation would have killed me for sure. She then set us up with a family physician that she uses.
    My lesson to all: Have a serious discussion with your MD. Make sure you feel comfortable and ask what would happen if you needed care in an emergency situation. Our new MD very sincerely told us he would be there for us, night or day and even gave me his home phone number. He was so appalled at how we had been treated, he never wanted us to go through something like that again.

    • Susan Czarnecki

      Ruth,
        My heart aches for you. My story is very similar only my physicians were my colleagues of many years. By the time I got what I needed I have metastatic disease, a difficult daily life with moments of terror. I no longer even bother to expect support for the difficult times or even bother to tell the docs, just pray to God I don’t die in the treatment process. My husband and I hang onto each other. I am glad you have found a true physician. A rare gift in this world, a lot of docs, but very few physicians.

    • http://pulse.yahoo.com/_UDJTUH45CFUC6LKCBLB6FGRDKU Diane

      First of all, I am terribly sorry you went thru the pain and agony of the deal of your child, mother and unemployment in such a short time. That is Agony for anyone. Secondly, while you had to get your new doctor the hardest way possible, it is wonderful that you have found someone who is going to be there for you now.

      I do feel for your situation too. There are two of us at work who have been in your shoes. Both of us have had our symptoms dismissed by physicians only to have them turn out to be quite serious. There are just some of those folks out there that don’t seem to “get it”. I’ve made it a point to never let anyone in my family see those docs at our large family practice again – I’ll just tell them I’ll head to the doc in a box first, where amazingly, I’ve gotten excellent treatment for the kids for years for all those sorethroats after work, stitches, and mysterious rashes on weekends. As for my coworker, well, she is still suffering the consequences of Dr. I’m the Best who apparently failed to remember his own advice and messed up her surgery 6 months ago. After 3 corrective surgeries later (some by emergency docs on call) he tells her “your case doesn’t warrent the pain you say you are in”- uh, my belly’s been cut open 4 times and I have RA and a host of other problems? It took devine intervention by her trusty PCP to get her out of his care and into another surgeon to finally get her some decent treatment since she was a classic “train wreck” that noone else wanted.

  • http://expatdoctormom.com/ Expat Doctor Mom

    Great list! 

    I would like to say in #10, it is not that I as a physician don’t like a list, I review the complaints and then focus on taking care of them (as many as possible) in the visit.  There are times when patients have so many different complaints it is not realistic to address them all.  If you go to your cardiologist and have chest pain you spend at least 1/2 hour getting this symptom addressed, same goes for if you see a specialist for any other complaint.  10 separate complaints can take 1/2 the day to address.  It rarely happens that this is the case.  However, before we even get to this point, I talk to each and every patient at the very first visit on how to get their needs met: for sick visits, refills, needing an appointment when all are full for the day (I see patients even during lunch and at the end of the day along with leaving sick visits for same day visits), and let them know they can ask for an extended appointment times if they have multiple complaints. 

    I wrote an article on how to get your needs met in the doctor’s office:  http://expatdoctormom.com/2010/09/how-to-get-your-needs-met-at-the-doctors-office-in-3-easy-steps/

    On number 9, some patients like being given an opinion on what the best treatment option is and some want to have the top ones reviewed and make an informed decision.  I customize this to individual needs.

    Running late… many days I run on time or up to 15 minutes late.  If it is longer (there are patients who come in with emergencies (chest pain you stabilize and transport to the ER, lacerations that take time to sew) the patients are notified and given the option to wait or reschedule.

    Best,
    Rajka

  • Lane Meyer

    This list omits the number the one reason doctors lose patients now days.  Changes in their insurance.

  • Anonymous

    I would like to add one.  Taking cell phone calls during a session.  I had a psychiatrist take a cell phone call from his son because the kid’s Xbox stopped working. I realize that his children are important and I would be sympathetic to an actual emergency involving the child but an Xbox issue is just a bit much to be endured on my insurance company’s dime.

  • http://twitter.com/LittlePatient Haleh

    An incredible list- I agree with everyone and vote music over tv. 

    One addition:  Being Open to Alternative Remedies.  Nothing is more a turn off than a doctor who doesn’t even acknowledge that it’s possible that he doesn’t have all the answers.  And doing so won’t stop a patient from trying an alternative remedy.  Better to acknowledge what your patient is bringing to the table and help guide him as well. 

    Haleh Rabizadeh Resnick, Speaker and Author of Little Patient Big Doctor
    http://www.littlepatientbigdoctor.com

  • http://pulse.yahoo.com/_UDJTUH45CFUC6LKCBLB6FGRDKU Diane

    I’m still waffling about changing PCP’s b/c of long wait times for appts.

    We like our family doc very much but he has a 2 month appt even for acute problems, so we never really see him. Just made an appt for a physical and it was 4 months. I was shocked I could get in so soon. But I’ve always thought this particular doctor was really on top of things and I value his diagnostic skills, advice and opinion. Unfortunately, I haven’t found that to be the case with some of the other docs in the practice.

    They do advertise “same day appts”, and it’s usually true, but you never know who it will be. And it doesn’t mean they will want to follow up with you for an acute problem if your doctor happens to be on vacation for a couple weeks, so continuity goes down the drain. And they have one guy who will barely come in the room if you have poison ivy b/c “he’s allergic to it”. (Don’t even start that with me-you can read the newspaper and find out how poison ivy is spread.)

    But finding a new doctor is just as hard. There are 6-7 in our large practice and 3 NP but the turnover in the past 20 yrs has been fairly high. Our doctor is the most senior and he wasn’t there when we came. We love the family practice concept though a recent search found only a couple other practices in the area. Maybe when the kids are grown and have moved away we can move on. Though I’ve already told my husband if our doctor moves to a concierge practice, I might follow him. Several of the other docs, including our 1st one did this. Our kids were preschoolers and we were healthy. Now I’ve got some health problems and want to be around long enough to see the grandkids-having a great “home” doc (along with my many specialists) could make all the difference in the world…

  • Anonymous

    Not infrequently, I’ll “lose” a patient because I want to. Maybe the have a dreaded “disease” such as FIBROMYALGIA!!!!!! Maybe they make taking care of them virtually impossible. Maybe every ancillary staff person knows them by their first and last name, and they grown when they hear they’re being admitted AGAIN. It’s easy to lose them….just very politely and professionally don’t do what they want and/or don’t give them what they want. Then they will bless your life by dramatically firing you. 

    • http://www.facebook.com/profile.php?id=100000444007524 MelodyAnne Dickson Sanders

      I feel sorry for you. Shame on you! People who choose to be in the medical field I have generally found to be caring and receptive to taking care of people …That’s what we got into the field for! You  have definitely opened my eyes, and thanks to you a lot of people whom read or will read your post will question any medical personnel on their intentions! Thanks for setting our field back!

  • http://twitter.com/reachpatients CN Henley

    I agree wholeheartedly with Dominic about #10 – we should at least copy or take lists of symptoms or meeds or timelines. It was important enough to the patient to spend time on, and regardless of the clinical situation, acknowledging and affirming this effort is important.

    It’s part of creating an *experience* the patient remembers as positive, not just delivering an emotion-less list of treatments.

    In a recent post on my website I use an old video of Steve Jobs to illustrate this exact point.

    Also, as clinicians we walk a fine line between giving black and white answers (like “take this medicine”) and keeping the patient involved in decisions (“let me know what you prefer to do”). I think there is room for a balance here.

    Hence why medicine should never be practiced by guideline fiat or dictum…

    Good list – thanks, Dominic!

    Noel
    http://www.reachpatients.com

  • http://twitter.com/PriscAquila Ifechukwu Ibeme

    Good advice for my fellow doctors. Good job.

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