An ND takes notes on a clipboard while talking to a patient.

Can You Spot a Potentially Problematic Patient?

If your inner voice tells you to “watch out” when it comes to a patient, listen to it.

Doctors are often shocked when they’re sued, but there are often warning signs along the way. If your inner voice is sending up warning flares, pay attention. Every patient interaction is different, of course, but keep an eye out for these situations that can be problematic. 

First-Timers

Lawsuits are often brought by people who are new to the practice. Taking a complete history and using an informed consent process is in your best interest. This is especially true for patients who see you for the first time. By thoroughly explaining what your treatment plan entails, the precise nature of the treatment to be rendered, the expected results, and possible risks, new patients are much more likely to feel at ease with the care you provide.

Patients who have seen a different naturopath can be critical of a new doctor, especially those with a different approach from what they’re used to. Patients often say in depositions, “my other doctor didn’t do that.” If you’re treating someone who has seen a naturopath in the past, it is wise to have an early conversation about how their prior experience might differ from your approach.

Chronic or Doctor-Shopping Patients

Some patients present with a chronic course of multiple vague or exaggerated symptoms and often suffer from anxiety, depression, and personality disorders. They likely have a history of numerous diagnostic tests with no definitive results.

If you have already accepted the patient into your practice and believe naturopathic care can help, be compassionate and understand. These patients may simply be frustrated that no one has been able to uncover the cause of their health problems.

Address the issue directly and early to establish expectations. For example, “I noticed you have seen several doctors and have had extensive tests to try to uncover the root of your problems. I recognize the symptoms are a real difficulty for you, but I believe any serious health problems have been ruled out. I would like to try a course of conservative care that has worked well for patients of mine with similar symptoms. If after two weeks, you haven’t improved, we’ll try another approach.”

As always, get information about the patient’s healthcare (with the patient’s permission) from previously treating doctors. If other doctors are still in the picture, make sure to coordinate the patient’s care and treatment with them.

Caveat

If the patient tells you about the “terrible doctors” he’s seen, this is a major red flag. If you haven’t begun treatment already, it may be best to tell the patient to find another doctor.

Questioning Patients

Beware of patients who clearly imply a lack of confidence in your expertise by questioning everything you say and do. With these patients, a three-tiered approach may be advisable.

  1. Take the time to thoroughly explain your decisions—even more so than you normally do. Go over X-rays or test results, review their progress frequently and answer all questions. Make sure your staff keeps you in the loop about any comments, complaints, or questions so that you can follow up with the patient directly.
  2. When a patient is questioning everything, sometimes they really want a second opinion but won’t come out and say so. Read between the lines and ask if they would prefer to see another or a different doctor or specialist. If a health insurance plan refuses to authorize a referral for a second opinion, patients have the option to pay for it out of pocket if they’re concerned.
  3. Document everything they say and everything you do, including discussion or a request for a referral. Keep complete, legible records of the treatment, your communications with the patient and family members, your opinion on whether a referral is necessary, and any efforts you made to coordinate the patient referral. It is good to give patients the names and phone numbers for the referrals and note them in the chart.

Angry Patients

It’s not surprising that an angry patient is the one doctors most dislike. But the anger a patient displays toward you or the practice may not really be the underlying reason for his frustration, and it’s possible you can help.

Perhaps the patient is going through relationship problems. A referral to a mental health professional may be advisable. Or, if they’re experiencing financial difficulties, a payment schedule may help.

When you see signs of an angry patient, it’s critical to diffuse the situation. Define your boundaries and empathize with the patient. Don’t get drawn into the conflict. Instead, use reflective statements such as, “I can understand why you might feel that way.”

If the patient is angry due to an adverse outcome, some studies suggest an apology might avert a lawsuit. In most states, an apology is not an admission of guilt and is not admissible as evidence. (Check your state law for specific requirements.)

Even if you’re confident you did nothing wrong, it can be helpful to follow up with care and concern. In these situations, after a two-week cooling-off period, offer to go over the charts and explain the treatments given. This may be all the patient needs to feel comfortable with the care you provided.

Unfortunately, there may be times when the patient refuses your efforts. In these situations, if you sense a potential danger to you or your staff, ask for assistance from law enforcement and remove staff members from harm’s way.

Protect Yourself

Ideally, try to spot problem patients before initiating a doctor/patient relationship. The best strategy for many of these situations is to tell the patient that you are not a good fit and they would be best served by finding another doctor. After you’ve embarked on a care plan, it is more difficult to terminate the doctor/patient relationship.

It’s important not to let down your guard with existing patients—even those who have been with you a long time and with whom you have a good rapport. Life can negatively impact physical and mental health. Stay alert and watch for signs of potential trouble.

Even if you take all the necessary steps, it’s still possible you may face a claim, but the chances will be reduced. What’s more, your patients will see you as a caring doctor—a doctor they’ll want to reward with their loyalty.

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