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Medical Justice

Making healthcare safe for doctors


Risk Management

Cease and Desist

10/16/17 11:47 AM

If you’re a surgeon, I have little doubt you have done a stellar job in selecting your patients. You’ve never made a mistake. Never looked back and wondered “What was I thinking?” Never overruled your staff when they detected “red flags.” Never talked yourself into accepting a patient for the operating room when you’ve had nagging doubts whether the patient had realistic expectations. If this characterizes your history over decades, you have a follow-up career in writing fiction.   

If you practice long enough, you will have some patient you wish you had not touched. 

This is not a discussion about recognizing red flags. Or why you should be careful in rationalizing signs detected by your staff. Or a treatise about managing expectations.  

I’m assuming you’ve already operated on the patient. They are unhappy. You regret it. And they have no intention of moving on quietly. Their single mission now is to be heard.  

Fair enough.  

It’s not unreasonable for a patient to communicate constructively with their surgeon. They want to get better. And reasonable people can disagree.  

And if a patient is legitimately injured due to negligence, they have remedies. They can file a lawsuit. They can complain to the Board.  

What about patients who barrage the practice with nasty emails, phone calls, and picket the office? 

These are difficult problems because they disrupt the office, sap morale, and make it harder for other patients to access care.  

If you can de-escalate the conflict, then try. You lose nothing by listening. And you may be able to solve the problem. Many doctors have succeeded at this stage merely by being a sounding board. Anybody can have a bad day or a bad week. If a patient needs hand holding during a rough patch, listening might just do the trick. If you are in listening mode, then don’t interrupt after 8 seconds. Honestly listen.  

Some patients have a history of psychiatric problems and might benefit from seeing a psychologist or psychiatrist. Or maybe the psychiatric issues are new and they might still benefit from a professional assessment. I know of some patients with newly diagnosed bipolar type 2 after major surgery. They appreciated getting help. Some might have had minor symptoms prior to surgery that were ignored. Once they saw a psychiatrist and were helped, they felt like a new person. 

Some patients might benefit from getting a second opinion to reassure them that they are on track for their recovery. I’ve seen some doctors even pay to have these patients seen by a respected colleague. Money well spent.  

Sometimes it’s a money issue. The patient is ready to move on, but they do not believe they got what they bargained for. In the cash-pay elective surgical fields, those specialists occasionally do give patients some or all of their money back in exchange for a complete release. Or they will perform touch up surgery where they waive their professional fee (if it makes sense to continue seeing the patient – since once you re-operate, you’ve extended the relationship). This often brings peace. Note, if the practice does this a couple of times a year, then it’s just the cost of doing business. If the practice is doing this 30 times a year, there’s a bigger problem that needs to be solved. 

The guiding principle is each of these cases must be approached and handled on an individual basis. 

OK, what is none of the above works and the patient is hell-bent on disrupting the practice and they have escalated their attacks? Now what? 

Obviously you cannot continue the doctor-patient relationship. It will likely need to be terminated in the proper way. You cannot abandon a patient. But there are formal ways to move the relationship towards closure. 

If you reasonably believe the patient is a threat to the safety of other patients, staff, or you, report this to the police. And you may have to hire a guard to protect your practice. Not a common experience. But over the lifetime of Medical Justice I have spoken with a number of doctors who did temporarily hire a guard. Not a single physician regretted that decision.  

Once reported, the matter can continue in the courts with a restraining order. This is uncommon. But sometimes it is the only way to move forward. 

And if the patient engages in assault or battery, or something worse, they can be arrested and charged with a criminal offense. 

Fortunately, such events are not common. But they cannot be ignored. The average doctor sees between 1,000 and 3,000 patients a year. Humans are complex. We cannot predict every behavioral outcome. We get wiser as we get older. But our judgment will never be perfect. 

What do you think? Share your comments below.


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Posted by Medical Justice | in Risk Management | 1 Comment »
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EasyE
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EasyE

The incidence of wacky patients is increasing. I’m one of the docs who hired an armed guard after a disgruntled patient scared the crap out of our staff (and me), and threatened to come to the office. In our case, the guard was a retired cop who sat in the waiting room unobtrusively with a concealed hand-cannon. The patient never showed, and I took the opportunity to call and engage the patient on speaker phone so the guard could hear the lunacy. He suggested going to the Police with a copy of the threatening email chain. The patient got a… Read more »