Patient conflict bites.
“I expected you to make me better. You made me worse. I’m thinking about speaking to an attorney. Also, I want the whole world to know so they can be forewarned.”
Doctors want to treat as many patients as reasonably possible. Our careers are long. And when we do retire, we rarely leave the world of medicine forever. But if you practice long enough, you’ll treat them. Who? Angry patients. It sucks, but it’s an inevitable part of the job. We all go through it. If this is the world you are living in now, welcome into the fold.
The “good” news: Doctors can do a lot to de-escalate conflict with an angry patient. The “even better” news: This article will share general tips and set you on the right track. Angry patients are inevitable. But knowing how to safely de-escalate the inevitable is invaluable.
This piece answers the following questions:
How can a doctor de-escalate conflict with an angry patient?
What can a doctor do?
What can a doctor not do?
When, if ever, is it appropriate to invoke legal tools?
Medical Justice has been helping member doctors safely navigate patient conflict (and a bevy of other medico-legal issues) for nearly 20 years. De-escalating patient disputes is one of our many specialties. This article will dispense general tips. In addition to de-escalation tactics, we’ll discuss how to keep a conflict from escalating in the first place.
Some fast advice: If you are in the midst of conflict with a patient, request a consultation. Our team of experts (doctors and attorneys) will provide general counsel. Without further ado, onto the piece.
When de-escalating conflict with an angry patient, find out what the unhappy patient wants from you; if his request is reasonable, do your best to accommodate. Frequently, but not always, the request is reasonable…
What does the patient want? You must answer this question. Consult your staff. Someone at the practice, other than you, has likely interacted with this individual one-on-one. The clues are always present. Once you know why the patient is upset, formulate a potential remedy.
Patients are people. People do not become angry without a reason. It makes sense to them. The practice may not perceive the patient’s reason as “reasonable”, but the patient is rarely mad by default. Something has happened. They may have been surprised by an unexpected bill. They may have had an argument with your staff. They may have received a bad outcome or a grim prognosis. Once you’ve gathered your clues, we prescribe the following action: Pick up the phone.
Just call the patient. Ask them directly to explain the challenge. Tone is important. You are gathering information so that you can diagnose the problem. But instead of diagnosing an illness, you are diagnosing an attitude. A simple phone call, accompanied by a calm, concerned inquiry goes a long way in putting out fires. If the patient perceives you care, he will likely reciprocate. Teddy Roosevelt reportedly said, “People don’t care how much you know until they know how much you care.” Listen to the patient’s explanation. If his explanation is reasonable, consider accommodating him. Pick your battles. You will know what your practice can and cannot accommodate.
If you must refuse his request, consider presenting him with some options. A simple “No, but…” is often better received than just “No.” “Yes, if…” works EVEN better.
Avoid patient conflict by managing expectations…
We cannot change the fact we’ll one day encounter a difficult patient. But we can reduce the risk the doctor-patient relationship will sour by setting the correct expectations. This important point bears repeating. You must set the correct expectations.
Storm clouds gather when a patient’s expectations are not met. You, the doctor, can manage these expectations by providing the patient with information that sets his expectations accordingly. Set the pace. The patient is the author of his own experience – but you, the doctor, can become his “editor” if you set the pace. And how do doctors set the pace? By setting the correct expectations.
In setting reasonable expectations specific to recovery time, cost of care, wait times, etc., you scatter the storm clouds before they gather. We help our members craft documentation and processes that sets the correct expectations. And it is important to adjust this documentation to suit your practice’s style and competencies. Custom language is critical. If you need input crafting these materials, request a consultation. It is critical these templates are drafted by professionals. Attempting to write bullet-proof documentation without professional input is a high-risk maneuver.
So, you set the right expectations, investigated the cause of the patient’s anger, and attempted to dispense a solution. But alas – the patient is still angry. Now what?
If the patient has made it clear he cannot be pacified, it may be best to transfer care to a different doctor. Doing this right can result in multiple positive outcomes. The patient will get the care he wants or needs. You can move on with your work and focus on the needs of your practice and your other patients.
That said, doing this wrong will likely result in downward trajectory. Like an abandonment charge propelled by an even angrier patient. We will help you get this right – request a consultation to learn how we help you facilitate a complete and compliant transfer of care.
Now that we’ve discussed general tips for avoiding and de-escalating patient conflict, here are a few key warnings specific to patient conflict.
When de-escalating conflict with an angry patient, no matter what, keep the conflict offline...
If the patient posts online, the argument becomes publicly accessible. The public (existing and future patients) will be drawn to the conflict if the incensed patient makes enough noise. No practice has ever profited by arguing with a patient on the internet. If you can keep the dispute off the web, you prevent evidence of the argument from reaching the public. But if the patient goes online, the argument now exists in the public sphere. If the debate starts with a negative online review, do not take the bait. For more help here, read our article: 5 Golden Rules for Responding to Negative Patient Reviews.
And if the patient threatens to post a negative review online unless you satisfy his demands, understand that the patient is close to taking an action that may satisfy the definition of extortion. Once again, this is our wheelhouse and we can help. Request a consultation with our experts.
When de-escalating conflict with an angry patient, don’t be a wall. Be a human being...
If the patient requests (or demands) a refund, proceed with caution. But don’t become inflexible. If the patient has requested a refund for a modest amount of money, it may be best to refund his money – with some critical caveats. We can help you make this determination.
First, the patient must accept the refund is conditional. He will get his money back in exchange for signing an agreement that he will not return for more cash later. The language of the agreement must also prevent the patient from posting his negative sentiment online. To be clear – the purpose of furnishing a refund is to neutralize a dispute that has no alternative solution. The patient is mad and will remain so indefinitely. His only salve is cash.
The above scenario assumes the patient has demanded a refund, but nothing else. Meaning he has not threatened to injure your business if he does not get his desired refund. If the patient threatens (or even suggests) he will blast you online, the game changes. The patient has threatened an action that will likely satisfy the definition of extortion. This gives the physician leverage. Extortion is a crime.
That said, when de-escalating an angry patient, litigate sparingly...
When should a doctor involve the law? The conditions are very simple. If the patient makes threats of violence, call the police. If he’s just making an ass of himself, do not take the bait.
Our argument: An angry patient under the gun of litigation (for example, charging defamation) will lash out. He may contact the media. He’ll warn his friends. He’ll tell his family to stay away from your practice. These actions add up to headaches for your practice and bad outcomes for you. The temptation to use the law as a sword is strong, especially if you believe you’ll prevail.
Here’s a fact: Litigating with angry patients consumes more calories than most doctors expect. And proving defamation (at least according to the law) is difficult. An angry human cannot be dismissed as easily as a traffic ticket. If you take the patient to court, you will likely see more of him than you’ll see your own family. We aren’t kidding.
In closing – when de-escalating conflict with an angry patient, keep this summary close…
When meeting a patient for the first time, identify his key concerns and set expectations accordingly. Discuss recovery time, potential risks, potential outcomes, and the anticipated cost of care. Make sure that patient is a good fit for what you intend to do.
If the patient is already upset, contact him and determine the origin of the problem. Phones are your friends. And consult with your staff. Doctors are not full-time detectives, but some of our skills do overlap. Allowing the patient to fester in silence will make the situation worse. Human beings are not bonfires. Our emotions (typically) don’t fade when we are shut in a vacuum. We just get angrier.
If you are certain there is no remedy, or if the patient’s suggested remedy is unreasonable, be prepared to offer him a list of alternative solutions. If he cannot be pacified, be prepared to take responsibility for transferring his care to a different physician. This “hand-off” is a delicate process and must be done correctly to avoid being charged with patient abandonment. Medical Justice is more than equipped to help you nail this crucial process.
Next, keep debates offline. As soon as the patient goes online, he has seized the proverbial megaphone. The public has front-row seats. You must avoid this outcome. If this has already happened (or is happening now), contact us. This is another sphere where we can help you solve problems.
If the patient requests a refund, consider honoring the request if the amount is reasonable and the patient signs documentation stating the return of funds is conditional – i.e. he will not blast you online or deposit the check and return minutes later for seconds and thirds. Litigate sparingly. Propelling litigation against a patient will likely propel you, your patient, and your practice into spotlight. Don’t expect the media or the public to sympathize with your side.
Lastly and most importantly: Understand these challenges represent a mundane reality that every doctor must address. An angry patient doesn’t make you a bad doctor. It makes you a human being. Do not walk alone. You don’t have to walk alone. Medical Justice is equipped to help de-escalate an angry patient and drive you toward favorable outcomes.
As the sage wisdom goes: “You can please some of the people some of the time, but you cannot please all of the people all of the time.” It’s also said, “The customer is always right, but not everyone has to be YOUR customer, (or in this case, your patient.)”
Our counsel will help you please those patients who can be pleased – and help you safely and compliantly manage those who cannot. Request a consultation with our Founder and CEO, Jeff Segal, MD, JD.
What do you think of our suggestions? Have you ever had to de-escalate an angry patient? If so, what was the outcome? Comment below.
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Jeffrey Segal, MD, JD
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 over 50 combined years of 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.