Managing Your Practice

Addressing patients’ complaints


In the years since I last wrote about addressing patients’ complaints, the issues that prompt them have only grown, both in number and complexity. More than ever, it seems impossible to construct any sort of template for consistent, mutually satisfactory resolutions of such disputes.

Dr. Joseph S. Eastern, a dermatologist in Belleville, N.J.

Dr. Joseph S. Eastern

But it is possible, and it’s not as complex as it appears, once you realize what the vast majority of complaints have in common: Expectations have not been met. Sometimes it’s your fault, sometimes the patient’s, and often a bit of both, but either way, the result is the same: You have an unhappy patient, and you must deal with it.

Why, you might ask? Is the expenditure of time and effort necessary to resolve complaints really worth it? Absolutely, because the old cliché is true: A satisfied patient will refer five new patients, but a dissatisfied one will chase away twenty or more. Besides, if the complaint is significant, and you decline to resolve it, the patient is likely to find someone who will; and chances are you won’t like the choice, or the venue – or the resolution.

As such, this is not a job you should delegate. Unless the complaint is trivial or purely administrative, you should address it yourself. It’s what you would want if you were the complainant, and it’s often too important to trust to a subordinate.

I have distilled this unpleasant duty down to a three-part strategy:

  • Discover which expectations went unmet, and why.
  • Agree on a solution.
  • Learn from the experience, to prevent similar future complaints.

Of course, the easiest way to deal with complaints is to prevent as many as possible in the first place. Take the time to explain all treatments and procedures, and their most likely outcomes. Nip unrealistic expectations in the bud. Make it clear (preferably in writing) that reputable practitioners cannot guarantee perfect results. And, of course, document everything you have explained. Documentation is like garlic: There is no such thing as too much of it.

Of course, despite your best efforts at prevention, there will always be complaints, and handling them is a skill set worth honing, especially the one most of us do poorly: listening to the complaint.

Before you can resolve a problem you have to know what it is, and this is precisely the wrong time to make assumptions or jump to conclusions. So listen to the entire complaint without interrupting, defending, or justifying. Angry patients don’t care why the problem occurred, and they are not interested in your side of the story. This is not about you, so listen and understand.

As you listen, the unmet expectations will become clear. When the patient is finished, I like to summarize the complaint in that context: “So if I understand you correctly, you expected ‘X’ to happen, but ‘Y’ happened instead.” If I’m wrong, I modify my summary until the patient agrees that I understand the issue.

Once you know the problem, you can talk about a solution. The patient usually has one in mind – additional treatment, a referral elsewhere, a fee adjustment, or sometimes simply an apology. Consider it.

If the patient’s solution is reasonable, by all means, agree to it; if it is unreasonable, try to offer a reasonable alternative. The temptation here is to think more about protecting yourself than making the patient happy, but that often leads to bigger problems. Don’t be defensive. Again, this is not about you.

I am often asked if a refund is a reasonable option. Some patients (and lawyers) will interpret a refund as a tacit admission of guilt, so I generally try to avoid them. However, canceling a small fee or copay for an angry patient can be an expedient solution (particularly if it is still unpaid), and in my opinion, looks exactly like what it is: an honest effort to rectify the situation. But in general, additional materials or services, at reduced or waived fees, are a better alternative than refunding money.

Once you have arrived at a mutually satisfactory solution, again, document everything but consider reserving a “private” chart area for such documentation (unless it is a bona fide clinical issue), so that it won’t go out to referrers and other third parties with copies of your clinical notes. Also, consider having the patient sign off on the documentation, acknowledging that the complaint has been resolved.

Finally, always try to learn something from the experience. Ask yourself what you can do (or avoid doing) next time, and how you might prevent similar unrealistic expectations in a future situation.

Above all, never take complaints personally – even when they are personal. It’s always worth reminding yourself that no matter how hard you try, you will never please everyone.

Dr. Eastern practices dermatology and dermatologic surgery in Belleville, N.J. He is the author of numerous articles and textbook chapters, and is a longtime monthly columnist for Dermatology News. Write to him at [email protected].

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