Dr. Howard Steinman knows how to deal with unhappy patients: Have a blast.

"BLAST" is the acronym that Dr. Steinman, director of dermatologic and skin cancer surgery at Texas A&M College of Medicine in College Station, uses to outline steps dermatologists can take when dealing with an upset patient.

He outlined the BLAST method at the annual Hawaii Dermatology Seminar sponsored by Skin Disease Education Foundation:

- Believe. Believing is the "cornerstone" of the process, according to Dr. Steinman. "Express belief, even if the patient is exaggerating, lying, emotional or irrational, or incorrect," he said. "The patient believes you have harmed or wronged them; belittle or trivialize their belief at your peril."

- Listen. Stop the mind and mouth and listen to what the patient is saying - let them vent, said Dr. Steinman, who is also an associate professor of medicine at Texas A&M. Give them a "magic minute" to get out all their grievances. "Do not mentally react and start preparing your rebuttal," he added. "Pause, relax, clear your head, and stay calm." That means not getting upset with patients who are rude or angry, or who swear, threaten, or repeat their complaints more than once.

After the patient has finished talking, restate the patient's concerns in a relaxed tone: "What I hear you saying is that you expected all of the lines and redness to be gone by now." The statement may need to be rephrased or repeated or until the patient is satisfied, Dr. Steinman said. Phrasing the statement in terms of an expectation is helpful, especially if the patient's expectation is not appropriate or accurate. He added that although physicians should listen and clarify, they should never try to defend or justify. "The patient doesn't care," Dr. Steinman said. "They want solutions, not excuses."

- Apologize. Making an apology does not mean acceptance of legal responsibility, he noted. Instead, just apologize for what the patient is experiencing and for their unmet expectations. "Apologize even if you did nothing wrong," said Dr. Steinman. "The patient feels they have a legitimate complaint and expects an apology. A sincere apology will diffuse much of the patient's fear, frustration, and anger." Examples of apologies might include, "I'm sorry the Botox treatment caused your eyelid to droop," or "I'm sorry the laser treatment did not remove all of your brown spots, but sometimes several treatments are required."

One patient of Dr. Steinman's experienced significant crusting and prolonged erythema after a filler injection to the glabella. "At my initial session when she noted the complication, I apologized and reassured her I would make every effort to make it right for her," he said in an interview. "Her upset abated at that point; she eventually completely healed, and all follow-up visits went smoothly."

- Satisfy. This means solving the patient's concerns. Explain their options, the time frame for improvement, and whether the problem can be completely solved, Dr. Steinman said. Be sure to make yourself available to the patient in the form of more visits or phone calls.

- Thank. Wrap up by thanking the patient for the second chance; for giving you the information that something occurred that upset them; for staying in your practice; and for not damaging your reputation.

As for whether to discharge unhappy patients, Dr. Steinman said he would consider doing so only after several calls or office visits attempting to solve the problem did not work, or if the patient was "persistently abusive to my staff; persistently unhappy about perceived deficiencies in how they were treated by myself or my staff; were upset over fees and the issue could not be resolved; or if they had acceptable results and were still not satisfied, and I couldn't find a way to satisfy their concerns." He added that he "would not discharge a patient if they had experienced a serious side effect or complication from a procedure, even if they were abusive or unhappy. But I might not agree to perform any new cosmetic services."

"When dealing with upset patients, we often become anxious, defensive, or angry. BLAST is very effective for defusing, redirecting, and correcting these situations, whether they are related to the family, the social arena, or business. It also gives the doctor a mental framework that will give him greater confidence and less anxiety when having to deal with an unhappy patient. Rather than wanting to avoid a confrontation, I simply say to myself, 'This is going to be a BLAST as I enter the room," he concluded.

Dr. Steinman had no relevant conflicts of interest. SDEF and this news organization are owned by Elsevier.

Dealing With Unhappy Patients Can Be a "BLAST"