Managing Challenging Patients

I’m sure we’ve all experienced such scenarios in our private practices: the patient who challenges us on almost everything in our patient policies, from paying co-pays on time to compliance with professional advice.

Well of course they get better, which is why they come back.

However, they can be a challenging patient to contend with, and your staff will begin to anticipate that issues will arise with every visit.

Oftentimes in my experience, their initial exam goes well, but then the challenges began to fly. “I can’t possibly be here next week. Co-pays are how much? You’re not here Fridays?…”

After the exam, I walk them to the front desk, and ask my receptionist to schedule a second visit appointment. Then, within earshot of the entire waiting room, the complaints begin: “You expect me to pay how much today? What do you mean my insurance doesn’t cover XYZ?…”  

Of course we all have our bad moments. But here we’re talking about the chronic complainers who don’t follow advice and push back on you and your staff on almost every detail. I approach such patients and explain, “You just will not get better if you can’t follow advice. I am sorry, I can’t help you. I’ll tell my staff I’ll see you on an as needed basis-just call or walk-in. I wish you all the best”.

Fast forward a bit and I’m down back with patients. Then I walk back to my office for the next patient, and guess who is scheduling a treatment plan with the front desk?

Doctor, I can’t tell you how many times this low stress. Low-key approach to patient care planning has worked for me, and still does, even as I train new doctors.

There are of course some caveats.

The challenging patient must know that non-compliance usually means you’ll be forced to refer them on. I tell every patient that non-compliance means a higher liability risk for me and a likely discharge from my care, right up front.

You and your staff must document exactly what’s going on. If it’s poor insurance, finances, time, or willful non-compliance.

Whatever it is, you can’t write it often enough. Have your staff do an entry too if the patient becomes belligerent or disrespectful.

But, strive to train your staff to screen prospective patients better.

Lets face it, people are stressed and confused enough about their healthcare benefits as is.

I have really seen the value in this while treating many elderly patients. Most are sweet, and grateful. But more than one in ten in this age group has been tough on my team. Some can be downright nasty when they find out about any non-covered services they must pay for.

So, I have the business office call all new patients before the first visit to review the ABN.

Then at the front desk, before any other paperwork on their first day, the receptionist reviews the ABN and non-covered services. And you know what? Two or three every month still walk out.

Then, rather than making my receptionist feel bad because of a walkout, I compliment her on eliminating a trouble case up front, and keeping the office peace.

Tough approach? You bet!

But, you see, the doctor must set the ground rules. It’s the doctor’s license, liability, and reputation.

Some patients will just never get better, no fault of ours. Seems some even find pride in trying to make you wrong, or as miserable as they are.

Most however are sweet, kind and very appreciative. They’re supportive, and continuously refer their friends and family. In fact, in my waning days of practice I appreciate them more and more.

Some of my sickest patients have overcome extreme adversity, yet still smile and pay their bills at every visit. The sheer human impact of this inspires me to do all I can for them.

And I know it’s the same for you too. But only if you lovingly but firmly run the office.

Remember, the real power is in the continued improvement of your systems.

Make sure you take the time to meet with your team, and really go through these encounters step by step.

You’ll be happier, busier, and more prosperous too.

I wish you the best along your journeys!

Want to learn more about how to build your private practice?

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Have a great day!


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