Risk Management

Message from the Chairman—Hostile Patients

Over the past five years, OMIC has witnessed a steep drop in the number of claims and lawsuits reported by its members, from a high of 284 in 2003 to 203 in 2008. At the same time, the number of OMIC insureds increased from 3,200 in 2003 to 3,939 by year-end 2008. While we are delighted to see this downward trend, there has been a dramatic increase in the number of reported “incidents” (potential claims) to OMIC’s claims and risk management departments. Nearly 6% of OMIC insureds reported an incident in 2008, up from a low of 2.7% in 2004. Many of these incident reports relate to behavior problems, i.e., difficult, noncompliant, and hostile patients. What accounts for this increase?

Recent membership data from the American Academy of Ophthalmology indicates that the average ophthalmologist sees 114 patients per week. Collectively, OMIC insured ophthalmologists, now numbering nearly 4,100, see over 450,000 patients per week. Thus, it is not surprising that some of these patients and their family members will confront us with challenging behavioral problems such as those cited in the lead article.

As this summer’s angry “town hall” meetings and ongoing health care reform debate in Congress demonstrate, people are angry and fearful about the system and the health care being provided. Patients are confronted with a dizzying array of unfamiliar procedures, treatment options, and medication regimens. Issues around insurance and paying for care can further confuse and stress patients.

Physicians have a duty to their staff and other patients to provide a civil and safe practice environment, but disruptive patients expose us, our staff, and other patients to potentially abusive, violent behavior. They can affect our bottom line as well. Non-payment for services, time taken away from providing care to other patients, responding to litigation or regulatory complaints, and even, in some cases, the need for damage-control public relations all take their toll.

This year, OMIC began offering a risk management course, Difficult Physician-Patient Relationships. Some of the situations addressed include dealing with hostile and noncompliant patients, communicating with patients who are deaf or limited English speaking, and what to do when patients have vision problems that impair their ability to drive (see this issue’s Hotline article). In addition, OMIC’s web site offers a wealth of protocols on the subject of difficult patients, and risk management staff are available to answer questions and provide guidance to insureds and their staff, who are asked to apply their best clinical judgment even when faced with angry ultimatums from patients.

OMIC risk management staff have learned that one way to prevent frustration and keep patients informed is to provide procedure- specific patient education documents and videos produced by the Academy together with informed consent documents provided by OMIC. Although education is not a fool-proof method of eliminating patient dissatisfaction, it can go a long way toward making the health care you provide more understandable.

Richard L. Abbott, MD OMIC Chairman of the Board