Demanding Patients and Families
If some difficult patients are noncompliant,
others are demanding. They may tell the physician what medication to
prescribe, what test to order, and often what narcotic will prove most
effective. Others demand frequent and immediate access to the physician.
They expect the office staff to bend schedules, to break rules, and to
abandon established office protocol to accommodate them. When their
wishes are denied, some may threaten to "go to the papers" or to sue;
others may become verbally or physically abusive. A few may even begin
stalking the physician.
Some physicians accede to the wishes of
demanding patients and their families because they don't know how to say
no. These physicians are among those most vulnerable to malpractice
litigation. In trying to achieve the superhuman goal of being everything
to everyone, they drive themselves to exhaustion. That, in turn, leads
to mistakes or oversights and to patients who are either disappointed or
angry to discover the fallibility of the physician they once thought
infallible.
Physicians should not allow themselves to be
manipulated by their patients or their patients' families. Neither
should they succumb to their threats. The best way to avoid both
situations is to establish and adhere to practice guidelines. They
should be detailed in the philosophy statement shared with every patient
at the initial visit and should be repeatedly underscored for those who
ignore them.
Risk Management Suggestions
The following suggestions are offered to help
physicians deal with patients who repeatedly present with unrealistic
demands:
- Acknowledge personal and professional
limits. It is better to do some things
well than to fail at trying to do everything.
- Set limits with patients and strictly
adhere to them. If someone abuses the
telephone, for example, be available to him or her during set times
only. If he/she is verbally abusive to staff, talk with the patient and
let him/her know that the professional relationship will be terminated
if the behavior persists. If he/she demands antibiotics for a virus, try
to educate him or her. If he/she is seeking drugs that are not needed
for a medical condition, refer him/her to a therapist or enrollment in a
detoxification program. In all instances, follow established protocol
exactly so that a one-time exception does not become the expected
rule.
- Have the patient or family name one
person in the group as the "point
person" for all professional conversations about a sick relative. Trying
to answer one question multiple times wastes time that might better be
spent with patients.
- Make sure a patient's informed
consent/refusal and advance directive are in order. Initially, it can save time and argument. If the
patient becomes incompetent, it may save the physician from litigation
or help protect him/her if a suit alleging negligence is
filed.
- Do not enter into an argument with the
patient or family. Determine what the
patient/family envisions the needs to be and why. Then, to the extent
possible, empathize with the situation and explain to, educate, and try
to reason with the patient/family about the need to approach the matter
from a medically optimal perspective.
- Do not be intimidated by the threat of a
lawsuit. Doing -- and documenting --
what is medically justified can be argued far more successfully in a
malpractice case than giving in to a patient whose demands may be based
on nothing more than television advertisements or information gleaned
from questionable websites.
- Summon police help if a patient becomes
physically violent. Try to isolate
him/her to prevent injury to staff or other patients, try to calm
him/her, and, if possible, try to reason with him/her.
- Notify the police if a patient continues stalking -- either out of
anger or perceived "love" -- after being confronted about his/her
behavior. A restraining order may be the necessary next
step.
- Terminate the professional
relationship with patients whose
behavior interferes with the ability to render appropriate medical
care.
Next Page: Non-payment of Bills
|
