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A roadmap for managing unhappy patients
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However careful we are with the way we treat patients, all of us will occasionally encounter someone who is unhappy with our care. Here is a list of principles from a variety of experts that will serve you well in helping your own patients.
Welcome the complaints. My partners and I tell our patients, “If you’re happy with the way we treat you, tell your friends. If you’re unhappy with the way we treat you, tell us.” We also teach our technicians and staff not to pass over any softly worded complaint from a patient but rather bring it to our attention. Most often, a complaint expressed subtly to a staff member is expressed dramatically to the patient’s friends. And while a happy patient will tell three friends about you, but an unhappy patient will tell 10.
State the patient’s complaint before the patient has an opportunity to. Sometimes we know before seeing a patient that he or she is unhappy. The patient may make a remark to a staff member or say so when scheduling an appointment. Take advantage of this knowledge to build a bridge between you and the patient. There’s nothing more disarming to an unhappy patient than to have his or her doctor walk in and say, “Mr. Jones, I don’t think I’d be very happy with my vision if I were you.” Suddenly, you’ve changed your role with the patient from adversary to ally.
Validate the patient’s complaint. If the patient voices a complaint, don’t ever brush it off or minimize it. Simply restating the complaint in different words is an effective way to express that you understand and are concerned about the patient’s issue.
Be unapologetic about the limitations of technology and surgery. When a 20/30 patient complains about visual acuity a week after cataract surgery, one of my colleagues likes to say, “If you had a hip replacement, you wouldn’t be concerned about not being able to run a marathon the next day. This was major surgery on your eye. It’s going to take time to heal.” Similar statements can be made about multifocal or accommodative lenses. Giving patients this kind of perspective is valuable, accurate and puts the “blame” on a third party – the eye, the implant or the healing process. Bringing a third party into the discussion (not the patient, not you, but the eye) is a valuable way to take the pressure off your relationship with the patient.
Provide options. As Primary Care Optometry News Editorial Board member John W. Potter, OD, MA, a lecturer in dispute resolution and conflict management at Southern Methodist University, likes to teach, when discussing a solution to a patient’s problem, it’s always best to give two choices. “Mrs. Smith, it looks like your eyes are dry after your PRK surgery. I expect that this is going to get better, so we should continue our treatment and give it additional time. Alternatively, we could do measurements now for an enhancement procedure, but I think that this is not your best course of action.” Giving the patient a second option like this shows that you are more than casually interested in his or her concern and that you have a back-up plan in mind. It reflects your competence to address the issue, as well. By the way, giving much more than two choices may confuse the patient and make him or her feel that you lack confidence in the best course of action. Either way, you should clearly state the course of action that you recommend, assuming you have a preference.
Run toward, not away from unhappy patients. My residency chairman, Julian Nussbaum, taught me that human nature is to run away from stress, but with unhappy patients a compassionate physician needs to do the opposite. Nothing reflects your interest in a patient’s well-being as much as your willingness to see the patient repeatedly, even making a house call for a patient who is having a particularly hard time or has transportation issues. We all tend to develop a natural friendship with people we see regularly. Doing this will only help melt that stress away and repair the trust between you.
When the relationship is broken, refer. Sometimes, despite your best efforts, a patient can lose confidence. It’s natural to feel hurt when this happens, especially when you have followed good standards of care. It can be difficult to swallow your pride and refer, but this is generally the best course of action. Usually the patient has already thought of changing doctors by this point, so your referral will probably be most welcomed. You should continue to be in contact with the patient to be a helpful resource or to welcome the patient back when and if confidence is restored.
Don’t throw other doctors under the bus. When we see patients who have had unsatisfactory results of treatment elsewhere, we have a real opportunity to soften the patient’s anger with the first doctor. This is almost always the right thing to do. Generally speaking, most of our colleagues do their best work for their patients with the patient’s best interest in mind, and we should clearly acknowledge this. My residency director, David Carey used to say, “If you see a little fire, put a little water on it, not a little gasoline.” We all deserve help from our colleagues occasionally and should spread goodwill at every opportunity.
I welcome comments regarding pearls you have found to be helpful in managing unhappy patients.