Risk Management

Patient’s Anger Could Land You in Court

By Michael R. Redmond, MD

Argus, July, 1991

Why do patients become angry? When people enter into medical treatment they are under stress. Having surrendered some of their independence and control to the medical team, they develop certain expectations of the physician or hospital. If these expectations are not met or if the medical outcome is disappointing, the patient may become frustrated by a perceived lack of empathy and concern from the physician, the office staff or even the hospital.

Communication with the patient from the first visit is absolutely essential to build a rapport of openness, confidence and trust. Pertinent family members should be included in discussions about the patient’s disease process, planned medical treatment or surgery. Personally introduce any consultants or partners who will participate in the patient’s care. Effective communication on the part of the physician conveys a message of caring, especially when a complication occurs, and goes a long way towards preventing surprises. The quality of the “service” received as perceived by the patient is of ultimate importance in preventing a lawsuit.

When a complication does occur, explain the situation to the patient and family immediately and candidly. Don’t give them any reason to believe you are avoiding the issue, i.e., avoiding a “mistake.” Empathy and sensitivity are especially important in these situations. Give the patient and family members the opportunity to express their feelings and concern. Allow more than the usual appointment time or schedule a special appointment.

Extra check-ups or visits may be helpful, even if they are not absolutely necessary for the patient’s care. One colleague whose patient developed a postoperative endophthalmitis following cataract surgery visited that patient every day in the hospital, even though another physician was now treating the endophthalmitis and the surgeon was on vacation from the office. The patient and family knew the surgeon was on vacation and that expression of concern and caring, genuine as it was, went a long way towards preventing a lawsuit in a case with a less than optimal outcome.

Whether to reduce or eliminate an angry patient’s bill is a question that comes up often and is answered in different ways. Often such action can be the best thing, especially with simple dissatisfaction or anger over an office encounter. By eliminating the fee, the doctor does not admit guilt, although it can be misrepresented and misconstrued as such in a courtroom.

Care must be exercised in pursuing an unpaid bill even if the physician feels 100 percent in the right. Aggressive bill collection can sometimes aggravate an angry patient and the threat of a malpractice suit is often used to stop collection proceedings.

While a good sound office collection policy will generally suffice, problem cases require individual attention and perhaps consultation with your legal representative or malpractice carrier.

Accurate and appropriate documentation, without emotion or editorialization, is critical in the office and hospital record. Include the patient’s medical course and any confrontations arising from patient dissatisfaction or anger. As always, it is critically important to document initial discussions with the patient, preoperative discussions, the elements of informed consent and lastly, discussions concerning “surprises” and efforts to resolve them.

On some occasions, the patient’s anger cannot be defused and a new treating physician may be in everyone’s best interest. Avoid any hint of abandonment with an orderly transition of the patient’s care.

Prevention is the key. But when problems do occur, make every attempt to resolve them openly and promptly to everyone’s satisfaction.