CASE 4: THE
UNHAPPY PATIENT
Case 4:
A 32-year-old female had had numerous cosmetic procedures performed by
the same plastic surgeon. The patient expressed displeasure with the
scar left by a procedure performed to remove a nevus in the
periumbilical region. The physician revised the scar at his own expense.
However, the new scar led to new complaints and the patient’s
demanding monetary compensation. The physician called ProMutual Group to
ask if he had sufficient reason to terminate the professional
relationship.
Unhappy patients are usually a
benign presence in a practice. Occasionally, however, their unhappiness
with the physician or an outcome may lead to anger, which may, in turn,
lead to litigation. The patient who expresses unhappiness with the
administration of the practice might help bring about needed procedural
changes. A discussion with the patient who continually demands special
attention (see Case 5) may-or may not result in behavioral
changes. Patients who are unhappy with the results of treatment,
including surgical procedure, represent a different challenge.
Some of these problems may be averted if in the pre-procedure
period:
- The physician does not promise more than he or she can deliver,
- The screening criteria for elective procedures enable the physician
to identify and exclude patients with unrealistic expectations,
- The informed consent includes all likely risks.
When the patient is unhappy despite
all the efforts of the physician, termination may be the best
recourse. The physician should let the patient know that he or she
has done all within his or her professional power and, with the
patient’s interests at heart, feels that it would be in the
patient’s best interest to continue care elsewhere. The
procedure outlined earlier in this article should then be
followed. If, as in this case, the patient insists on remaining in
the practice, the physician must be firm and express concern at his or
her inability to meet the patient’s expectations and then persist
in following the termination process. Whenever treatment is still
underway termination should be deferred until there is little likelihood
that it can be considered abandonment.
Returning all or part of a
professional fee to an unhappy patient is a business decision that must
be made by each practice on a case-by-case basis. Physicians
seeking advice about whether and how to engage in such a practice would
be well advised to consult an attorney or to call their medical
malpractice insurance company.
Next Page: Case
5: Excessive Demands
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