How not to handle rude patient behavior

Deb Beaulieu

Deb Beaulieu

Last week, I posed a question to you about how physicians can handle patients who don't always tell the truth. Dishonesty is one of the undesirable patient traits that sometimes come with the job. So is dealing with patients who are rude and inconsiderate.

This column offers a bit of a twist on our usual focus on addressing patients' peeves. With medical professionals facing burnout at unprecedented rates and their workloads and stress expected only to get higher, it's vital that practices develop strategies for coping with unfair treatment that comes their way.

For starters, let's be clear about what not to do, as evidenced by this USA Today video reporting on a Mercy Hospital OB/GYN's Facebook post complaining about patient tardiness.

The post read as follows: "So I have a patient who has chosen to either no-show or be late (sometimes hours) for all of her prenatal visits, ultrasounds and NSTs. She is now three hours late for her induction. May I show up late to her delivery?"

In response to ensuing comments on her post, the doctor wrote: "Here is the explanation why I have put up with it/not cancelled induction: prior stillbirth."

Following the incident, a Mercy spokesperson released a statement apologizing for the posting, adding that although the organization's compliance staff did not deem the writing a privacy violation, it was indeed inappropriate and not in line with the hospital's values.

Some of the doctor's other former patients gave interviews, vouching for her excellence as a doctor and said they did not think the OB/GYN should lose her job over the incident.

Whether you agree with that opinion, I'd like to warn other doctors who may be tempted to vent similar frustrations via social media. The information provided in those two posts might be enough for other patients to put two and two together and identify the patient. Even in a large practice, people talk.

To give the physician the benefit of the doubt, she was probably justifiably fed up with having her time disrespected. It's also understandable that she'd be reluctant to reschedule the patient, given her high-risk status.

However, there are other ways she could have confronted the patient other than a passive aggressive, potentially humiliating post in a public forum.

She could have spoken to the patient directly, if not during one of her delayed appointments then during an after-hours phone call. It's even possible someone other than the physician, such as an office manager or administrator, could have called or sent a letter explaining how showing up late to appointments affects other patients, and provided a warning that the practice would have the right to reschedule or even dismiss the patient as a consequence for future violations.

In a recent post in Clinical Advisor, Robyn Carlisle, a midwife at University Doctors and Kennedy University Hospital in Sewell, N.J., shared some of the strategies she employs in treating patients whose behavior is disrespectful.

"Just last week, I had a young patient who was so busy sending text messages while I was taking her history that I had to repeat most of my questions multiple times," she wrote. "I finally asked her to put her cell phone away, pointing out the large sign that instructs that all cell phones are to be turned off during visits."

This is a good example of a physician using direct communication to resolve a situation, backed up by posted office policies.

Carlisle went on to describe her own frustration with late patients.

"Chronic lateness is another pet peeve of mine. …Our office gives a standard 15-minute grace period, but I have patients who tend to show up more than half an hour late for every visit and then get disgruntled when we reschedule their appointment," she wrote. "I try my best to stay on schedule and have respect for my patients' time, I only ask that they return the courtesy."

Of course, there is no perfect solution. There's a chance that a disgruntled patient, or one who will simply never be satisfied, may be more likely to sue the doctor or practice. There's no surefire way to know, but if you ultimately decide that dismissing the patient is the best path for both of you, be sure to provide adequate notice and referral to another doctor to avoid running afoul of patient-abandonment laws.

So how does your practice approach this problem? Have you been able to turn any patients' bad behavior around? Any lessons you've learned from experience, please share with your fellow FiercePracticeManagement readers! - Deb (@PracticeMgt)