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Dealing with difficult patients is something that when we train to be medical assistants gets over looked. We have course in professionalism which many assume eliminate the problem. We are not always the source of anger or misunderstanding that our patients display. If is wise to have an office policy in place that gets everyone on the same page when it comes to our approach to deal with difficult patients. I would divide most difficult patients into two groups; front office and exam room. Here I will deal with the difficult patient in the front office.
The front office difficult patient is one who is often upset with staff about scheduling, billing, and prescription refill issues. Many times these are patients who do not understand that their insurance does not give them a totally free ride when it comes to care. When they get the bill for their portion of care they are usually convinced the office billed their insurance wrong. Sometimes they suffer from sticker shock when they see the amount of their co pay that has accumulated when they have had a condition that required numerous office visits. The patient who is suffering from medical bill sticker shock can be dealt with. First it helps to have someone doing the billing in the office that is willing to talk to patients about their financial responsibility. If a patient has a forty dollar co pay for an office visit and their treatment is going to require several follow up visits they need to be informed. It is simply best practice to collect the co pay upfront so the bill does not become exorbitant in the first place. New patients should not just be handed an office payment policy.
They should be verbally informed that payment is expected at the time of service for their co payment. If patient’s have questions about how much of their treatment is covered by insurance, someone in the office should be willing to help them find out. Since we do not have crystal balls and can not predict how well treatment will go, we need to emphasize that it is only an estimate. Ultimately, it is the patient’s duty to deal with their financial obligations to the practice. Most patients new or established will not admit when they are in financial difficulty. They wish to keep such matters private until they are unable to pay their bills.
Again, if your office offers financial arrangements for patients who are going to have default paying their share of the bill they should know about this policy before they need it. Discussion of a patient’s financial hardship should take place in a private setting and only staff that does the billing needs to be aware of their circumstance. The financial health of a patient should be guarded information just as their medical information is. The patient that is upset about scheduling is many times an established patient.
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They may have been in the practice when it was relatively new or had more staff. They became used to being able to have a wide variety of choices when it to seeing the doctor or nurse fractioned. They also may feel entitled to see the doctor when they want because they have been loyal to the practice. This patient needs to be told that all patients are accommodated the best way possible when they call for an appointment.
They also may need to be reminded that those with serious conditions are seen sooner then those patients who are being seen for routine matters. It helps to thank these patient’s for their patience and offer to really work to schedule them at the next most convent time for them. You will not always win this battle as some people because of social position are catered to by their hair dressers, mechanics, and other service professionals.
They simply will not understand that the doctor’s office is not in the business of catering to the busy professional schedule. In this case you may recommend a walk-in or urgent care clinic in case this patient’s will not give up their insistence on being seen immediately. This action should not be taken with out consulting the health fractioned first. You also may have the option of offering these patients the opportunity to see another doctor in the practice with a more open schedule. Patient’s that are upset about prescription issues again should receive a copy of the office policy in regard to refills.
If they call a dedicated line for refills they need to know that you will take at least one business day to respond. If they insist on refills on a medication that has expired, they need to understand they may need to come in and see the doctor in order to have the prescription renewed. You have to stand strong on your practices policy. This is especially true in regard to controlled substances. Many states have strict regulations that must be followed when dealing with the class of drugs.
Lastly, electronic prescriptions and changes in drug formularies are issues you have little control over. You should always advise a patient to wait 24 hrs and call the pharmacy to see if an electronic prescription has been filled. You should encourage patients to put long term prescriptions on automatic refill. You can call on patient’s behalf if they have issues getting their electronic prescriptions filled, but as long as you have done it right on your end there is little you can do about the speed at which the pharmacy on the other end. Most doctors will change a prescription to something covered by the patient’s insurance, but it is the patient or their care takers job to find out what prescriptions are covered and which are not. Sometimes for medical reasons an doctor will petition the insurance company to cover a certain drug, but this is a cumbersome process and can not be done for every patient.Communication is the best way to avoid angry or frustrated patients in the front office
. You should always be respectful and honest about the things you can and can not help the patient with. Most people will calm down and do their part to solve the problem if you are clear on what you can do to help them deal with their particular issue.
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