Engaging With The Unhappy Patient

Following up with dissatisfied or unhappy patients can be stressful and nerve wracking. Tensions, fueled by anger and frustration, can run high even after some time has passed.

Physicians might think following up with an unhappy patient will be unproductive and overly time-consuming. However, a 10-minute phone call with clearer heads might be a worthy investment in preventing a lawsuit or complaint to a licensing board or third-party payor. The call can also positively affect a potential jury’s or licensing board investigator’s perception of the physician.

Reasons for Contacting Unhappy or Dissatisfied Patients

There are at least two solid reasons why the MICA Risk Team often recommends that physicians reach out to dissatisfied or unhappy patients.

First, patients often file complaints or threaten litigation when they feel unheard or disrespected. Patients might believe that filing a complaint or lawsuit is the only way to get their opinion heard. Affirmatively engaging in a discussion with an unhappy or dissatisfied patient can give the patient a chance to voice their opinion and might dissuade the patient from filing a complaint or lawsuit.

Second, medical professional liability claim data supports reaching out to unhappy or dissatisfied patients. A large national study concluded that communication plays a key role in medical malpractice claims.¹ In the study, 53% of the communication-based claims involved communication between patients and their physician or health care provider.² Additionally, communication-based claims were less likely to be dropped, denied, or dismissed than claims that did not involve communication failures.³

Preventing Dissatisfaction with Patients

Even before patients become unhappy or dissatisfied, physicians might consider attempting to “meet patients where they are.” For example, physicians might consider where the patient is in the diagnostic process, where they are during treatment, or where they are while recovering or healing.

Dr. Mark Hughes provided a case and commentary in the AMA Journal of Ethics describing a patient who did not believe his physician appreciated the difficulties behind the patient’s failure to change his diet, lose weight, exercise, stop smoking, and get to his appointments on time. Dr. Hughes suggests physicians guide their patients through a tour of their care and coach patients through the challenges of their care. As a tour guide or a coach, physicians can educate and share the lead with patients, while cheering the patient toward a positive result. To educate and co-lead, physicians must understand where their patients are and guide or coach at that level with the appropriate style, tone, and wording.

Even if patients do not understand the clinical reasoning behind a physician’s choice of diagnosis or recommendation for treatment, they might appreciate the physician’s effort to have a meaningful discussion. Their appreciation might lead them to decline further thought of filing a complaint or lawsuit.

Addressing Dissatisfaction with Patients

Physicians should quickly clear up misunderstandings with patients. Patients might perceive an outcome as “bad,” when the outcome was simply unexpected. Alternatively, patients might perceive the physician as mad or disappointed, if the physician dispenses with pleasantries or small talk due to time constraints. Physicians might explain, for example, that an outcome is not final, or it provided valuable clinical information to inform future care. By clearing up misunderstandings, physicians promote their patients’ understanding of the full scope of their condition, treatment, or recovery. A feeling of understanding might dissuade patients from filing complaints or lawsuits.

Affirmatively engaging unhappy or dissatisfied patients in a discussion gives patients one less reason to file a complaint, and it shows an investigator that you “heard” the patient and respectfully tried to address the concern. A serious source of dissatisfaction is an adverse outcome.

Following an adverse event, patients often want to understand what happened and why. Patients who believe their physician explained a bad outcome and sincerely apologized might be less likely to file a licensing board complaint or lawsuit. Additionally, some states have “apology laws” that can provide protections for physicians who participate in an apology discussion. For more information on apology laws, see What You Need to Know About Your State's Apology Law in the Southwest.

A licensing board investigator and a plaintiff’s attorney will base their initial thoughts and plan of action on a review of the patient’s medical record. If a physician does not address the clinical situation in the patient’s complaint, the investigator or attorney might assume the physician ignored the situation. A jury of laypeople might relate the physician’s appearance of inaction to a dissatisfactory experience with their own physician. Jury members might be unable to separate their own negative experience from the defendant physician, and they might render a decision against the defendant physician as a result.

Documentation of contacting patients, discussing outcomes and concerns, and planning next steps help investigators, attorneys, and juries see physicians as sympathetic and understanding. Physicians are also more likely to seem thorough by following up with patients’ concerns.

Steps To Take When Meeting with an Unhappy Patient

• • Consider meeting with the patient in person. This shows the patient you are willing to invest your time in them. When meeting in person, physicians can employ non-verbal cues which can influence how patients perceive their tone, words, and intentions.
    
    
  • Remain calm. Attempt to de-escalate the situation by conveying calmness and understanding. If you meet with the patient in person, make eye contact with the patient. Eye contact and leaning toward patients reassures them of your engagement.
    
    
  • Document the discussion. Patients may not recall these follow-up conversations and might deny that they occurred. They might also dispute the physician’s recollection of the conversation. Documentation of the discussion supports physicians’ recall of conversations and might sway an investigator not to pursue further investigation.
    
    
  • Consider reporting to the MICA Claim Department any bad or unexpected patient outcomes, patients’ threats to get a lawyer or file a complaint, and other situations that leave you feeling uneasy. You can reach the MICA Claim Department at 800-352-0402 or log into your MICA account via the website and click “Report a Claim or Potential Claim” at the bottom of the page.
    
    

^{[1] Kate E. Humphrey, MD, MPH et al., Frequency and Nature of Communication and Handoff Failures in Medical Malpractice Claims, 00 J. Patient Safety 00, 1 (2021).
[2] Id.
[3] Id.}