Patient Dissatisfaction and Malpractice

Money Disputes

Out-of-pocket costs for medical care are skyrocketing. With the increasingly impersonal nature of the medical encounter and the commercialization of health care, patients are more apt to become dissatisfied and be less tolerant of errors. Recall that medical school taught us to first elicit the patient's chief medical complaint. Nowadays, too often the first question is: “Do you have insurance?” Or “what kind of coverage do you have?” In such a practice environment, more injured patients can be expected to retaliate, especially if they feel unjustifiably overcharged.

Inform the patient at the outset regarding cost estimates for consultations, procedures, and so on. Such discussions may be relegated to an experienced and professional staff member, and the doctor himself or herself need not be directly involved. However, this should be done before the service is provided. Ambiguities, followed by an unpleasant surprise concerning money matters, will likely upset patients, especially those with an adverse medical outcome. Great tact and sensitivity is necessary to avoid turning such a situation into a malpractice claim. This is not to say that only good clinical results deserve to be paid for. However, a bill that is perceived as being unreasonably large may just get an injured patient angry enough to file suit.

In addition, when patients don't pay their bills, many of us resort to a debt collection agency without first speaking directly to the patient. If possible, physicians should first try to resolve the issue, for example, by offering a generous installment payment plan. The funds owed may not amount to much in an individual case, and aggressive pursuit may prove counterproductive. Consider adopting a policy of writing off unpaid bills in the name of public service, although this may be impractical for some institutions or when large sums are owed.

Contact the author at siang@hawaii.edu.