Most patients are happy with their choice of doctor. They appreciate the job their doctors do. There’s a mutual respect.
If only that were the case with all patients.
I spoke with one surgeon last week. He admitted if he had known how difficult one patient would have been, he would have prevented her from scheduling an appointment. In fact, with the benefit of hindsight, he would have actually paid her to never come to his office. Or more preferentially, to have encouraged her to schedule with another surgeon.
The surgery was performed within the standard of care. The objective results were quite good. Perfect? Well, no. Almost no surgery is done perfectly. We get close. But perfection is an elusive goal.
This patient then became disrespectful to the doctor. To the staff. She was demanding. Loud. Threatening.
The magic was gone.
The surgeon said it would be worth paying her $500 or even $1,000 to go away. He had nothing else to offer her medically. And he just wanted to be left in peace and tend to his other patients who valued his time.
Normally people are paid for doing something. For an action or activity. For labor.
Not always.
At times, the government paid farmers to not grow crops. Why? To balance supply and demand in the marketplace. To achieve a policy objective.
Zappos, the shoe retailer, pays new employees to quit. That program, called Pay to Quit, extended the offer to its newest employees within the first few weeks post-hiring. Employees had to first be hired – so they were eminently qualified. Zappos would pay the new hires $1,000 to quit. Very few took the company up on its offer. Amazon, which purchased Zappos in 2008, came up with similar type of program.
Once a year, the company offers to pay full-time associates at Amazon fulfillment centers up to $5,000 to leave the company. Employees are eligible after one year of service, but there is a caveat: Those who accept the offer can never work at Amazon again.
“We want people working at Amazon who want to be here,” Amazon spokesperson Melanie Etches tells CNBC Make It via email. “In the long-term, staying somewhere you don’t want to be isn’t healthy for our employees or for the company.”
The company offers $2,000 to employees who have been at the company one year, and the offer increases by $1,000 per year of tenure, maxing out at $5,000.
Amazon claims that they don’t actually want employees to accept the offer. In fact, the headline on the memo states “Please Don’t Take This Offer,” according to founder and CEO Jeff Bezos.
But according to Michael Burchell, workplace culture expert and author of the book “The Great Workplace: How to Build It, How to Keep It and Why It Matters,” it actually enhances employee engagement and is cost-effective in the long run.
Burchell says that employee engagement tends to be about two things: commitment to stay and discretionary effort. While Pay to Quit may not necessarily push employees to work harder, he says, it does address the issue of commitment to stay.
“If you choose to actually not take the money and you choose to stay, it means that you’re committed to the organization and committed to your work,” says Burchell. “It helps to frame the employer/employee bargain or that psychological contract.”
Disengaged employees cost their company about 34% of their salary. A disengaged employee making $50k/yr costs his company $17k in lost productivity. So, there’s a strong business rationale for paying disengaged workers to leave. (Of course, one can always fire that employee. But, the pay-to-quit option “smokes out” those employees who may never have reached the threshold of being noticed for their detrimental effect.) So, it’s a short-term cost in the hopes of long-term benefit.
Back to where we started, what is the cost of having to manage a disgruntled patient who is loud, aggressive, disrespectful, angry, and a time-suck (assuming there is nothing medically different that can be done for him/her)? Hard to say. But there is definitely a psychic cost, if not an actual economic cost.
I can see why some doctors would pay select patients to quit.
The elephant in the room – patient abandonment is serious business. Before terminating a relationship with a patient, you must ensure continuity of care. We’ve already published a piece that addresses some of the high-level issues at play.
Implementing bullet-proof patient dismissal letters will save you time and money – and potential lawsuits. Medical Justice has perfected such documentation. Member doctors benefit from a bevy of other powerful medico-legal resources.
Click here to discover the benefits of membership – or click here to join now…
What do you think? Join the conversation developing below…
Jeffrey Segal, MD, JD, FACS
Chief Executive Officer and Founder
Dr. Jeffrey Segal, Chief Executive Officer and Founder of Medical Justice, is a board-certified neurosurgeon. Dr. Segal is a Fellow of the American College of Surgeons; the American College of Legal Medicine; and the American Association of Neurological Surgeons. He is also a member of the North American Spine Society. In the process of conceiving, funding, developing, and growing Medical Justice, Dr. Segal has established himself as one of the country’s leading authorities on medical malpractice issues, counterclaims, and internet-based assaults on reputation.
Dr. Segal was a practicing neurosurgeon for approximately ten years, during which time he also played an active role as a participant on various state-sanctioned medical review panels designed to decrease the incidence of meritless medical malpractice cases.
Dr. Segal holds a M.D. from Baylor College of Medicine, where he also completed a neurosurgical residency. Dr. Segal served as a Spinal Surgery Fellow at The University of South Florida Medical School. He is a member of Phi Beta Kappa as well as the AOA Medical Honor Society. Dr. Segal received his B.A. from the University of Texas and graduated with a J.D. from Concord Law School with highest honors.
In 2000, he co-founded and served as CEO of DarPharma, Inc, a biotechnology company in Chapel Hill, NC, focused on the discovery and development of first-of-class pharmaceuticals for neuropsychiatric disorders.
Dr. Segal is also a partner at Byrd Adatto, a national business and health care law firm. With decades of combined experience in serving doctors, dentists, and other providers, Byrd Adatto has a national pedigree to address most legal issues that arise in the business and practice of medicine.
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During my training, the doctor/owner of the practice had a nightmare, irrational, demanding patient. On a follow up, the doctor got so fed up with the patient’s bad attitude and unrealistic expectations that he took out his wallet and said, “how much do I need to pay you, to leave, and never come back?” Followed up by slapping $50 bills on the counter.
The patient eventually settled on $150 in cash.
Next, he escorted him to the front desk, and loud enough for the waiting room to hear, “This man can NOT be satisfied! Give him a full refund, a copy of his records, and three names of eye doctors in the area.”
This doctor was my hero and was eventually my best man at my wedding!
I recently was assigned to a new physician in a family practice after our prior family physician retired. When we showed up for our assigned appointment (our annual checkup), we were told that the family physician we were told we were assigned to, would not see us. The clerk told us that we had missed too many appointments. This was a flat out lie since we had not missed any appointments, we only had the annual follow appointment. The clerk after scurrying off to the back room came back and said that we had not missed any appointments. However the doctor (who we had never met) would not see us. The clerk stated that the doctor had the right to refuse to see us and she would not see us, and that we were assigned to another physician. We were in fact assigned to a senior physician in his 70s, who was a fine physician. But we are afraid that he will retire and we will be passed to yet another physician.
My wife was livid with the clerk’s statements. I had to calm her down and tell her that I would handle this. It was either to be seen by the physician we were assigned to, or we were not going to be seen at all. Since we needed our prescriptions refilled we went ahead with the appointment with the physician we were reassigned to. But this is how hospital employed physician practices are run. This would never fly in a private practice. And this conversation was held with us in the waiting room behind the glass partition with the clerk. So much for patient privacy. This was embarrassing because we felt like unwanted goods for an unknown reason. And the physician we were supposed to have an appointment with was supposedly not there that day. My wife wanted to be confrontational. I did not. I do not enjoy being a patient and I do not enjoy being treated like a cog in a wheel. But I guess this is what medicine has come to. Now I would pay to not ever cross paths with this physician that I never met that rejected us for unknown reasons even though she had never met us!!!
I could be wrong, but your situation looks like a case of mistaken identity. If you have a commonly held last name, that would definitely be possible. She checked to see if you had missed any appointments, so allegedly she had you correct. Still could be mistaken identity.
I understand your anger. After thought is always easy to give. I think I would have asked the clerk at the desk if in fact they were “confusing me with someone else.”
If you had a complaint against your previous doctor or other doctors in that group practice, the NEW doctor might have some valid concerns…perhaps valid…perhaps not. If you had comments on your chart that “you did not follow instructions” that might be a red light too.
There is more to this pie than just baking. My guess is that there is more, even if you are not aware of it.
Michael M. Rosenblatt, DPM
If a patient doesn’t seem to be “normal” during a consultation, it’s best to let them go. Normal patients are reasonable people who are looking for help, and who express themselves in a clear, and courteous fashion. Even these patients may become disgruntled in time…
Sometimes we cannot predict the future after a consultation, and PITA patients will always be part of our lives. I’ve been tortured by some, and Medical Justice has been AWESOME for providing excellent counsel about firing these unwanted patients legally. Losing a bad apple may come with a fee if there are on-line posts that require removal. These discontented apples are at least 10 times louder sounding than the words of your happiest patients.
What would you do if the first words out of your patient’s mouth are: “I’m a Yelper”? I’d probably get paged to an emergency and get lost.
Many years ago, I performed a surgery on a young male patient. He had an excellent result and there were no complaints. The surgery involved bone. Apparently he was satisfied.
Unfortunately, during those early years of practice, the insurance company issued a check in both my name and the patient’s. The (honest) patient would sign the check and give it to me.
This patient forged my name and cashed it. I was poor then and needed the money. I eventually sent the patient to collection. We were never paid. I also called him and reached his father on the phone. He father said the “…his son got married and used my money for himself. He said his son was a ‘useless idiot’ and I was lucky to be done with him.”
A number of years later (about 11), he made an appointment with me at my new office location. As soon as I saw his name, I instructed my staff to “REFUSE to allow him to come back into the office, until or unless he paid me.” My staff told me that “he said he paid me.” I did not confront him in the reception room. I made a point out of staying away from him.
I knew that confronting him would not lead to anything positive for either of us. Thankfully he left.
Any statute of limitation on his (previous) surgery result had long since run out. I was not interested in getting stiffed again, or “refreshing” any risk of seeing him.
I still remember his name. I remember all of the names of the patients who forged my signature on their insurance checks. I was told it was impossible to “swear out a complaint” against these patients. I don’t understand that. But that is what I was told.
I always thought that forging a signature on a check was illegal. Apparently that is OK if you are a patient of a doctor. Had I forged a signature I’m sure I would have not only lost my podiatry medical license, but also gone to jail.
I had school loan debts and my wife and I were poor. But that means nothing. Everyone knows doctors are rich….
Michael M. Rosenblatt, DPM
The process of seeking medical care now is unbelievable complex. There is an enormous administrative overload in the office from third parties, insurance companies, pre-approvals from pharmacies that are comprehensive to fill out and one often needs to review the entire chart to answer the questions properly. The time takes is not done during the clinical hours but afterwards on the physicians own time, and the charging usually takes many hours at night, every night.
The activity of creating a medical record often needs 3 professionals to enter data in the Electronic Medical Record so that it meets the Standard of Care from the government, its regulatory bodies, the insurance companies, medicaid, the Joint Commission, physician and administrative peer review,etc. The number of telephone calls coming into an office is simply overwhelming. Now with all of this, the cost of providing care has dramatically gone up and management has cut back on medical and clerical support staff.
Dramatic overwork of a chronic nature with no hope of improvement simply burns out the clerical staff, the nurses, and nursing assistants.
We hope that you, as a patient, could understand that your physician is no longer the Captain of the Ship, as he is now employed by others, and he has a boss, just like you probably had a boss, and, we all know that one must follow those dictates.
You can be sure of one thing: Your physicians and surgeons are equally frustrated as you in how the health care system has evolved. We invested our whole lives to give care to our patients.