Dealing with difficult patients will always be a challenge for any practice. The following steps can be used to help ensure that various situations can be defused and resolved appropriately.
Patients/family members should be given undivided attention, regardless of being face-to-face or on the phone, as this will help them to know they are being listened to. Allow them to explain their concerns without interruption and listen without attributing fault.
Reassure the patient/family member that their concerns are taken seriously, offering a statement of understanding without agreeing to fault on behalf of the practice, providers, or staff.
Attempt to identify the primary and any underlying reasons of the concern. This will help determine the best course of action on how to properly handle the concern.
A.C.T. (Appear Calm and Tactful)
Regardless of the type of situation, active listening works best. Responses and suggestions should be professional and simple. Be sure to summarize what the patient/family member has stated and suggest possible solutions to the issue (if feasible). In addition, providing assurance that the appropriate personnel (eg Practice Manager, provider, etc) will be informed can also help alleviate the situation.
Remember to always remain calm and professional even if the situation escalates and the patient/family member becomes angry and/or verbally abusive. Keep a safe distance and do not respond until the verbal barrage is over. Should the situation become physical, the proper law enforcement authorities should be contacted immediately.
Conclude & Document
Acknowledge the patient/family member's feelings and thank them for taking time to address their concern. Patient and family satisfaction should be considered a critical component of quality patient care. It is best to try to find areas of agreement; however, this may not always be feasible.
It is essential to document any concern whether it be in the patient's EHR or in written form. A simple documentation form can be used by either the provider/staff member or by the patient/family, and should include the patient's name, date of the concern, overview of the concern, as well as a description of any action taken (Sample Patient Concern Form).
Communication Strategies for Discontinuing Contracted Insurances
A practice may opt to leave an insurance network for a number of reasons. It is helpful to notify patients/families who are covered by that insurance company about this change as soon as feasible, so that they have time to plan.
Patients/families need to be informed of the date that the practice will no longer be accepting their health insurance, and the fact that they may want to identify another medical home that accepts their insurance. Alternatively, the patient/family could pay out-of-pocket for care, switch insurance products during their next open enrollment period, or talk to their employer's benefits manager.
Additional suggestions for the practice include:
- Offer to meet with affected patients and families – either individually or, if there is enough demand, in a group setting to answer any questions and/or concerns they may have.
- Develop a list of referrals for other pediatricians who participate in the insurance plan to share with families who are interested in staying within their current network.
- Waive the fee for providing patients with copies of their medical records; offer to provide them in whatever manner is most convenient for the families (eg, mail them directly to their new pediatrician) at no additional cost.
Discharging Patients from the Practice
A doctor-patient relationship can be terminated for many reasons. Whether the end of the doctor-patient relationship is initiated by the patient or the pediatrician, particular safeguards should be taken to ensure that the separation is legally compliant and avoids allegations of patient abandonment.
The following guidelines should be followed when making the decision to discharge a patient from the pediatric practice.
- Determining Discharge – Patients can be removed from the practice for such reasons as requiring services of a different specialist, non-adherence with medical advice and/or patient appointments, as well as being disruptive or harassing staff. It is also imperative to determine if the patient will be dismissed from the pediatrician or from the entire practice. If the pediatrician is part of an integrated delivery system (IDS), then the patient may be dismissed from all specialists and practice sites.
- Discharge Warning – Patients and families should be informed about problematic behaviors and/or lack of compliance to office policies prior to removal from the practice. Some practices offer a three-strike rule before dismissal, which can be particularly effective for appointment no-shows.
- Develop a Discharge Letter – Once it has been deemed that the patient will be dismissed from the practice, they should be notified of their dismissal in writing. The letter should clearly explain the reasoning for the dismissal as well as include a timeline for continued care; typically, 30 days for emergency issues only. See sample patient discharge letter here.
- Send "Certified" Discharge Letter – Sending the discharge letter by certified mail and requesting a return receipt provides evidence that the dismissal has been communicated. A copy of the letter along with the signed returned receipt should be filed in the patient's medical record. If the patient fails to accept the certified letter, the returned, unopened letter should also be filed in the medical record.
- Communicate with Staff – Although the decision to end the doctor-patient relationship should only be made by the physician, staff also need to be notified once the determination has been made, particularly the front desk and nursing staff. This will ensure that appointments are not offered after the transition period.
- Approaches to the Difficult Patient/Parent Encounter (Pediatrics Article, January 2011)
- Sample Patient Concern Policy
- Sample Patient Discharge Letter
- What to Do When Parental Disagreements Spill into Your Office (AAP News, April 2015)
- Patient Dissatisfaction: Opportunity to Improve Quality, Reduce Risk (AAP News, October 2019)
- Sample Letter for Patients/Families: Practice Dropping Insurance Plan
- How to address vaccine hesitancy: New AAP report says dismissal a last resort – AAP News Article (August 2016)
American Academy of Pediatrics