Physicians Practice - July/August 2008 - (Page 47)

angry at the family, but you are angry at the family.” His strategy for dealing with unruly families? Suggest they seek a second opinion. “Life and death situations are very emotional for families and for physicians,” says Centor. “It’s healthy to bring in another doctor who can back up what you are saying, which helps the family accept remember, they can’t comply. At the end of each visit, ask your patient if she has any questions or concerns. Then ask her to repeat back your instructions. Even better: Provide a written summary of the diagnosis, recommended treatment plan, alternative options, and the potential risks and beneﬁts. Everyone, from sleep-deprived new moms to career- HELP THEM BE GOOD Provide a written summary of the diagnosis, recommended treatment plan, alternative options, and the potential risks and benefits. Everyone, from sleep-deprived new moms to careercentric yuppies to easily flustered senior citizens, will appreciate this. centric yuppies to easily ﬂustered senior citizens, will appreciate this. EMOTIONALLY NEEDY what you’ve already told them.” In a hospital setting, you might also obtain written conﬁrmation from the ethics committee that they agree with your prescribed course of treatment. THE NO-CAN-DO-ER Instead, try judicious, limited testing. Instead of an MRI, for example, opt for an X-ray. “When you’re dealing with these patients for the ﬁrst time, there’s inevitably some diagnostic testing that needs to be done to make sure we’re not missing something, but eventually, for patterns of physical symptoms that don’t have a strong biological basis, try the lower cost, less risky treatment instead — especially if it’s done for symbolic reasons,” says Wolf. Centor agrees. “I had one patient who had had 18 previous HIV tests [but had] done nothing in the interim to put himself at risk,” he says. “Every time I saw him he wanted a new test. Sometimes a request for a test is reasonable, but when it’s expensive, dangerous, or totally unnecessary, you have to explain to the patient why you’re not going to do that and you have to be willing to get ﬁred for it.” It may seem counterintuitive, but you might also try seeing somatizing patients more often. “I try to bring them back more frequently than they can come up with complaints,” says Wolf. Though not actively combative, the noncompliant patient can be equally frustrating. Patients ignore healthcare advice for a variety of reasons, including fear of possible side effects, cost concerns, a belief that the treatment will be ineffective, and language or cultural barriers, to name a few. You can help your patients stick with a treatment plan, however, by taking the time to explain the reason for the test or medication you’ve prescribed and the consequences of failing to follow through. Where possible, use visual aids — heart scans, blood pressure results — to help drive the point home. Here’s one more reason: Many people simply forget most of what you’ve told them. If they can’t WWW.PHYSICIANSPRACTICE.COM There is also, of course, the dependent or emotionally needy patient. “These patients want your attention all the time until it becomes suffocating,” says Centor. “They feel they’re the most important person in the world. They go from doctor to doctor until they ﬁnd you and they eventually leave you, too, when you can’t be there for them all the time.” You’ve likely dealt with such somatizing patients, who present with a mix of physical ailments for which there is no medical explanation. “This is very challenging for all of us,” says Wolf. He says that some studies suggest half of all patients have at least one complaint with no biomedical basis. “I think doctors get frustrated and a lot of us resort to testing as a way of not dealing with that patient — perhaps not consciously, but we really don’t know what else to do.” READ MORE ABOUT IT! Go to PhysiciansPractice.com for more information on improving patient relations: •Learn how to protect yourself from legal trouble created by difficult patients; Type “Don’t Be So Defensive” into our Search Articles Box online at www.PhysiciansPractice.com. •Would you like to proactively defuse difficult patients with excellent customer service skills? Type “Patient Relations: Your Complete Guide to Patient Service” into our Search Articles Box on our Web site, www.PhysiciansPractice.com. •Download a free e-book on handling difficult patients by visiting www.crisisprevention.com/ direct/difficultpatientviolence.asp (registration required). JULY/AUGUST 2008 | PHYSICIANS PRACTICE | 47 http://PhysiciansPractice.com http://www.PhysiciansPractice.com http://www.PhysiciansPractice.com http://www.crisisprevention.com/direct/difficultpatientviolence.asp http://www.crisisprevention.com/direct/difficultpatientviolence.asp http://WWW.PHYSICIANSPRACTICE.COM

Table of Contents Feed for the Digital Edition of Physicians Practice - July/August 2008

Physicians Practice - July/August 2008 Contents The Bigger Picture: Battle Royale in the EMR Market Letters Physicians Practice Pearls: Hire Right Noteworthy Cover Story: Healthcare Reform: Voting for Change Patient Relations: Dealing with Problem Patients The tech Doctor: Is Self-Service Medicine Inevitable? Technology: Do EMRs Make You a Better Doctor? The Guide Idealab: Cash-Only Care Still Works The Administrators Desk: Who’s in Charge? Ask The Experts What Went Wrong: ‘Why Our Great Idea Didn’t Work’ Coding Start It Up: How to Launch a Practice: Operations Partnership: Don't Let Partner Conflict Destroy Your Practice Appraisals: What’s Your Practice Worth? Getting Advice: How to Hire a Consultant Classifieds Advertiser Index

Physicians Practice - July/August 2008

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