A medical practice is no battleground. But sometimes it feels like one. Patient conflict is one of the many occupational hazards of practicing medicine. It is critical doctors and nurses (and all staff) understand how to de-escalate patient conflict before there is a bad outcome. And “bad outcome” is a big umbrella. You want to prevent acts of violence, obviously, but hostile patients, left unchecked, can make your staff resent working for you. You don’t want to lose valuable employees because you just don’t know how to de-escalate a conflict with a difficult patient.
To pile on, patient conflict often signals that another occupational hazard of medicine is forthcoming. Patients in conflict with their doctors frequently sue their doctors.
This article will describe broadly best practices specific to identifying and de-escalating patient conflict. We’re answering two important questions…
- How can doctors and their staff learn to recognize patient conflict before there’s an outburst?
- And in the event conflict is already ongoing, what can doctors do to put a stop to it without making the situation worse?
Before we begin, here’s some background about our organization – and why we are qualified to solve these problems.
Medical Justice exists to protect doctors from medico-legal threats. Frequently, these threats originate from conflicts with patients. We’ve devised solutions to every patient conflict situation you can imagine – we’ve been at it for 20+ years, and we’ve seen everything. Nothing surprises us. Our methods prioritize de-escalating a conflict before it boils over into something only legal action can address. And if legal action is necessary to protect your practice, we know how to do it. Our Founder and CEO, Jeff Segal, MD, JD, is a neurosurgeon and an attorney – he understands both medicine and the law viscerally.
If you are in conflict with a patient, we can help. Schedule a free consultation with our executive team.
How can doctors and their staff predict patient conflict before there’s an outburst?
Preventative care is almost always less expensive and less bloody than remedial care. If you can anticipate a problem before it manifests, you can neutralize it. Apply this logic to patient conflict. Monitor patient behavior and triage based on perceived volatility. Enlist the help of your entire practice. You engage the patient directly and can judge those at risk of creating a problem. But the value of your staff cannot be understated. They engage your patients in different environments – over the phone, while the patient is awaiting care, etc. You see one side of the patient’s behavior, they see another. And they’ve likely seen or heard things that, placed in the proper context, will help identify who is happy and who is not.
Here’s a quick and dirty list of red flags that frequently signal a patient will create future conflicts.
- Patient is combative; frequently argues with staff over small amounts of money/office wait-times; reasonable explanations (delay due to emergency) fall on deaf ears.
- Patient refers to previous doctors as “butchers” and “hacks.” The patient may flatter you, insisting that they’ve heard great things about you. “You’re not like those other guys!” Don’t swallow the bait. You will frequently become the next “butcher.”
- Patient does not commit to necessary follow-up treatment; this kind of patient can fly off the handle when their negligence contributes to a complication (such as an infection).
- Patient enters care with unrealistic expectations; believes the doctor has the power to work miracles; believes treatment will save their marriage, advance their career, etc. Turn these patients away, and if you cannot, manage their expectations.
- Patient fails to pay his bill on time and is unwilling to commit to a payment plan. Patients who pin insurance conflicts on the practice should also be considered a risk.
Assigning a numerical value to these events and maintaining rolling documentation can help your staff identify who is at risk of blowing their stack. When the numeric rises beyond a specific value, task your staff with contacting the patient directly. Seek understanding. If you identify why a patient is upset, you can identify what it will take to defuse the dynamite.
But what if the patient conflict is ongoing? What then?
First identify why the patient is upset. Then identify what the patient wants. Don’t underestimate the power of a phone call. The source of the conflict may be independent of the doctor and the practice – like a problem in the patient’s personal life, projected unfairly onto the doctor. While it isn’t the doctor’s responsibility to fix this kind of problem, understanding why the patient is upset is critical. You must gather this information. Resist the temptation to push this kind of call onto your staff. If the patient is directing his ire towards you (fairly or unfairly), tasking a member of your staff with engaging him will likely be perceived as a dodge.
Once you know why the patient is upset, ask the patient directly: “What do you want?”
If the “what” is reasonable and you believe has the power to put the conflict to bed, contact qualified legal counsel and bring them up to speed. They’ll determine the best way to satisfy the patient’s request without putting you at greater risk.
If it is obvious the doctor-patient relationship has decayed beyond salvation, your options are as follows.
- Identify what the patient wants – and then give it to him.
- Identify what the patient wants – and if his demand is unreasonable, release the patient.
Either event must be a transactional event with strict conditions. Typically, the patient will sign a contract stating that in exchange for the desired item (often cash), the patient will stop driving the conflict. This contract also releases the patient from the doctor’s care. It is critical the contract makes allowances for the complete and documented transfer of the patient’s care to a different physician. Otherwise, the doctor risks an abandonment charge.
Medical Justice is equipped to manage all kinds of patient conflicts. We’ve been protecting doctors from medico-legal threats for 20+ years – and we’ve seen it all. If you are in the midst of a conflict with a patient, know solutions exist. Schedule a free consultation with our executive team.
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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. Byrd Adatto was selected as a Best Law Firm in the 2021 edition of the “Best Law Firms” list by U.S. News – Best Lawyers. 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.