BECAUSE PATIENTS JUDGE YOUR SKILLS BY YOUR BEDSIDE MANNER
Doctors at a large hospital have gone on strike. Hospital officials say they will find out what the doctors’ demands are as soon as they can get a pharmacist to go read the picket signs!
Doctors with great bedside manner aren’t supposed to be angry. Unless you are the most relaxed unflinching individual, you will get angry with patients in certain situations. Anger can affect you performance, judgment, reputation, and health. If you find yourself becoming angry too often, it may be a manifestation of burnout, and even if you have infrequent bouts of anger, you should learn to control them.
“I called my allergist on a weekend with an emergency concern. He called me back and didn’t recognize that I was a fellow doctor who he knew rather well. I was shocked at his indignation that I called on the weekend. Once he realized it was me, his demeanor changed to that which it should be for every one of his patients on emergency calls.” Lesson: Don’t act miserable just because you are fed up with taking after hour calls. The person on the other end of the line is probably pretty miserable with their emergency concerns and fears. While these calls are often abusive and could wait until regular office hours, you accomplish very little by being miserable. If you really are that burned out, hire someone to take calls for you on the weekend.
Most often, anger is directed at patients who are belligerent, ignorant, uncooperative, or inconsiderate. You have to identify what gets you upset and find remedies. The habitually late patient readily upsets the time-obsessed doctor. Because the punctuality issue is so common, the remedy is addressed in the chapter on the waiting room.
A Dental Specialist
“With difficult patients, you get mad at them, mad at your staff and
mad at yourself.”
The Noncompliant Patient
Patients who don’t follow directions that result in failing treatment are another major reason for resentment. You know how difficult your procedures are and how prognosis is dependent on many factors including patient compliance. While some patients are negligent and others are just not capable of following directions, you may tend to take the resultant failure as a personal affront to your ability. You can help alleviate feelings of anger and resentment by documenting each time the patient is noncompliant. Not only will it help to redirect blame when the belligerent patient wants to challenge you, it protects you from a lawsuit, and serves as a reminder that the patient may not be a good candidate for certain procedures in the future.
It is annoying and anger-provoking to deal with patients who incessantly complain about fees, treatment plans, and the length of therapy. By making sure there are no misunderstandings about the fees and the insurance benefits, the type of treatment and the expected number of visits, you will reduce the resentment and anger associated with this type of patient.
If a patient complains in a frequent or unreasonable way, you must have the fortitude to refuse treatment in a professional non-hostile manner. Offering a less expensive alternative treatment or suggesting that the patient seek treatment at a teaching hospital or clinic may be the best advice.
Because being perfect in an imperfect world is the goal of all health-care providers, there is a particular pressure to perform at a high level of competence. You may experience anger directed at your staff for repeated mistakes. The remedy is to make sure you hire, train well, and fire as needed to develop and maintain the best staff possible. If you pay at the lower end of the pay scale you will not attract or retain the best people. Make sure you devote much energy to training your staff. Many doctors complain about incompetent staff but make no effort towards training.
A common but often unrecognized source of anger occurs when you can’t perform to the level of competence required. Physical and mental decline causes frustration and self-directed anger. It may even result in anger directed unjustifiably towards patients and staff. While physical and mental decline is usually a deficit associated with aging, it can affect practitioners at all ages if they experience any pathology that affects performance.
Something as simple as unrecognized changes in vision can affect performance. Small hand tremors, chronic back pain, stress, diminished memory, and depression are just a few of the maladies that can hurt performance and result in anger and frustration.
You must recognize physical or mental decline when it surfaces and adjust your practice accordingly. One of the best reasons to have disability insurance is to be able to leave practice when necessary rather than continue to place patients and yourself at risk.
The inability of some patients to understand complex treatment plans and options, fiscal responsibilities, and general directions can be both frustrating and anger provoking for the doctor.
You have a failure to communicate when a patient asks the same question ten times. You may find yourself becoming angry. Try to smile, take a deep breath and explain again using a diagram for your records and let the patient take home a copy. Because communication is one of the major pillars of bedside manner, remedies are addressed in the chapter devoted to such issues.
Treating foreign patients presents another source of anger and frustration. There is the possible failure to communicate due the language barrier, and unfamiliar customs may be interpreted as being rude, pushy, and belligerent.
Try to be more understanding and recognize that they may have a big disadvantage in communicating. Learn a few phrases in the language of foreigners you may see often in your practice. Not only will it help make them feel more comfortable, it can disarm belligerence they may express as a result of their frustrations in communicating.
Petulance and Diminished Tolerances
Patients who have excessively low tolerance to pain or extremely high levels of anxiety can make you angry. It’s often hard enough to perform technical procedures on the ideal patient, so confronting the anxious patient or the patient who jumps and screams while you are trying to concentrate can affect your performance, your emotional state, and your health.
As much as you may try to disassociate yourself from the problem patient, you must recognize you are human and entitled to have these feelings of anger and disgust. It is imperative to avoid acting on your emotions.
Because you don’t see these difficult patients everyday, you don’t get much practice in controlling your reaction to them. If you make a concerted effort to recognize that they are not acting difficult on purpose and that they have a true problem, you may be able to have your compassion win out. If you can’t dissociate the behavior from your feelings toward the patient, you must have an escape plan in place.
The escape plan is based on a polite and courteous discussion with the patient explaining that you will not be able to treat them. You must avoid putting blame on the patient (i.e. it’s not their fault that they gag, or jump or scream in the middle of a procedure) and try not to make them feel bad. This can be a touchy conversation, but as long as you know you can have it and dismiss the patient, you feel less pressured to perform under duress.
“Mr. Johnson, I really would like to help you, but I’m unable to work on you when you are so jumpy. I truly understand how difficult this is for you and I want you to get a good result, so I think it would be best to see another practitioner who has more success with anxiety (apprehension, pain control, etc.)”
“Mr. Smith, I know how difficult it is for you to have this procedure done, and I truly wish that I could help you, but I’m sorry that I won’t be able to do my job properly with the way you react to the needles I have to give. I think you will be able to get a much better result if you find a doctor who can either sedate you or give you full anesthesia so that you can be more comfortable.”
After these types of discussions, the patient will either welcome the suggestion, offer to change his behavior, or become belligerent. You have to be ready to deal with each scenario.
If he welcomes the suggestion, you should have the number of a practitioner who performs the procedure under anesthesia. Do some research into this referral since you can be held partially responsible for making a negligent referral if the doctor malpractices.
If the patient promises to try harder, that may be all it takes to modify the behavior to the point of becoming a reasonably decent patient. You still have the out if he can’t manage to perform as required.
If the patient becomes belligerent, be apologetic and again explain in a nice, non-condescending manner that it is for his benefit.
“Mr. Smith, I want you to have the best possible treatment outcome, and I can’t do my job in this manner. You would have a much better experience if you could be sedated for this and we don’t have that option in our office.”
Preconceived Provocation Toward Anger
Your staff can unintentionally make you dislike your next patient before you even meet them. They do this by telling you the negative experience they just had in their encounter with the patient.
“Dr. Jones, Mrs. Smith refused to let me take an x-ray and she won’t sign the informed consent or the insurance forms.”
We all know how you can’t wait to go in to meet Mrs. Smith. Some of you will enter on the offense, starting off the relationship on the wrong foot. Some practitioners will instruct their assistant to go in there and, “Tell Mrs. Smith, if she doesn’t sign the forms and let you take an x-ray, I won’t see her.”
That’s not the solution used by the doctor with great bedside manner.
Try not to prejudice your feelings with your staff’s disdain for the uncooperative patient. Sometimes the patient’s inappropriate behavior is innocent and your staff may be overreacting. You should always make your own judgments and respond with the wisdom and maturity of a caring professional.
“Hi, Mrs. Smith, I’m Dr. Jones. I understand you don’t want us to take an x-ray.”
The patient will usually give you their reason based on the fact that they had ten other x-rays at some other office, or they may tell you about their fear of cancer. You explain the importance of why you need another x-ray and assess the degree to which this patient may be unreasonable and need to be dismissed. Once the patient meets the doctor, they usually act like a different person and acquiesce to all of your needs.
The next time your assistant tells you your new patient was rude and threw the clipboard with the patient registration form at the staff, you will know not to be prejudiced. You will confront the patient as if he were a normal human being. If you determine that he is hostile, belligerent, threatening, uncooperative or otherwise repulsive, you should be the one to make the call about dismissing him, not your staff.
Learning that you don’t have to treat everybody should take a lot of the pressure off your psyche and help you to control your feelings. The expression of anger, frustration, resentment, and vengeance has no place in any professional relationship and it will destroy any semblance of bedside manner. It is much better to dismiss the patient who riles you than to punish them by childish, vindictive acts such as making them wait longer to see you or treating them inappropriately.