Can You Detect a Problem Patient?
Listen to your inner voice telling you to “watch out” when you encounter the following types of patients.
Posted in Risk Management on Thursday, January 2, 2020
Doctors are often shocked when they’re sued. But often there had been signs all along.
That’s why you need to listen to your inner voice telling you to “watch out” when you encounter the following types of patients:
A lot of lawsuits are brought by people who have never seen a chiropractor before or are new to the practice.
For all patients, but especially for patients who are seeing a chiropractor for the first time, taking a complete history and using an informed consent process is in the doctor’s best interest. By fully explaining what the chiropractic treatment entails, the precise nature of the treatment being rendered, the expected results and possible risks, new patients are much more likely to feel at ease with the care provided.
On a slightly different note, patients who have been seeing a different chiropractor or multiple chiropractors over many years are more likely to be critical of a DC who uses a different technique or approach from what they’re accustomed to. Patients often say in depositions that “my other chiropractor didn’t do that.” Any newly treating DC should explain that not all chiropractors are alike and discuss with the patient how his approach might be different.
Chronic or Doctor-Shopping Patients
Some patients may 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 multiple diagnostic tests with no definitive results.
If you have already accepted the patient into your practice and you believe chiropractic care can help, be compassionate and understand these patients may simply be feeling frustrated that no one has been able to uncover the cause of their health problems.
Address the issue directly and early in the treatment process 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 chiropractic 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.
A 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.
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.
FIRST, make sure to take the time to fully explain your decisions—even more so than you normally do. Go over X-rays, review their progress frequently and answer all questions. Make sure your staff keeps you in the loop about any comments, complaints or questions, so you can follow up with the patient directly.
SECOND, sometimes when a patient is questioning everything, what they really want is a second opinion, but they won’t come out and say so. You need to read between the lines and see 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 really worried.
THIRD, document everything you do, including any 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 a good idea to give patients the names and phone numbers for the referrals and note them in the chart.
Many D.C.s say the angry patient is the one they most dislike. Bear in mind that the anger this patient displays toward you or the practice may not really be the underlying reason for his frustration, and you may be able to help.
For example, if the patient is going through relationship problems, a referral to a mental health professional may be advisable. In the event of a financial problem that is exacerbated by his bills for chiropractic care, a payment schedule may help.
However, some patients may vent their anger by hiring a malpractice attorney no matter what the underlying cause. That’s why when you see the 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.
Conversely, there may be times when the patient is simply enraged and inconsolable. 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.
Ideally, you should try to recognize 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 that the patient would be best served by finding another doctor. Once you embark on a treatment plan, it becomes much more difficult to terminate the doctor/patient relationship later on.
Moreover, it’s important not to let down your guard with existing patients—even those who have been with your practice a long time and with whom you have a good rapport. Stay alert and watch for signs of potential trouble.
Even if you take all the necessary steps, it’s still possible you will be sued, but your chances of a lawsuit 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.