Lancaster Physician Spring 2021 - 13

SPRING 2021

hysician offices work with people
when often fear, anxiety, and uncertainty are combined with feeling
poorly. Health care workers accept
this challenge and strive to assist patients
through these difficult times. Occasionally,
however, there are patients who are not merely
difficult but problematic. Their behaviors may
include verbal abuse such as profanity, implying threats to their self or others, and making
inappropriate demands-to name a few.
Often, staff members have attempted to
work through the problematic behaviors for an
extended period before bringing the situation
to the office manager's attention. By this time,
the behavior has increased in severity, resulting in staff members no longer being able to
cope. Frequently the call is for immediate and
drastic action. Unless the patient is causing
immediate disruption to the practice or posing
a physical threat, it is important to not jump
to conclusions but take an organized approach
to addressing the problem. Every situation is
different; however, the steps below can help
manage virtually all challenges.
STEP 1 - UNDERSTAND THE FULL
SCOPE OF THE PROBLEM
The practice manager must be an unbiased
listener. Often, multiple employees each hold
a piece of the puzzle. Take time to interview
staff throughout the practice regarding their
interactions with the patient. Listen for clues to
identify potential contributing factors. Patients
will often confide different aspects of their
challenges to different team members. Speaking
with all team members may provide not only a
solid understanding of the problem behaviors
but also insight into the patient's needs and
challenges. Are their basic needs not being
met? Is the patient who always calls angry and
confused unable to read and therefore not able
to follow the care instructions? Many times,
the patient will not communicate these issues
directly but may leave clues through several
interactions.

STEP 2 - COLLABORATE WITH
ALL STAKEHOLDERS
Stakeholders will vary from practice to
practice and may change based on the specific
situation, but generally they should include
the primary provider, practice manager, and

managing physician. Communication and
collaboration are key elements for defining
the problem, determining a general goal in
addressing the problem, and managing the
behavior consistently. Stakeholders must be
engaged in the process and willing to develop
and implement a plan.
STEP 3 - STRICTLY LIMIT THE
INDIVIDUALS COMMUNICATING
WITH THE PATIENT
Limiting the number of individuals who will
interact with the patient during this interim
time has multiple benefits. The burden of
managing impossible interactions with the
patient is lifted from the staff. Removing
the patient from the standard process often
reframes conversations and expectations for the
patient. Finally, at this point communication
needs to be very consistent. Limiting patient
communications to one or two individuals
allows for consistency and prevents the patient
from triangulating.
STEP 4 - CONSULT RISK MANAGEMENT AS SOON AS POSSIBLE
Once a desired outcome has been established, it is crucial to include Risk Management
to ensure both the desired outcome and path
to get there are appropriate. Full disclosure is
critical; the discussion needs to include not only
inappropriate actions by the patient but also
actions by the staff that may have contributed to
the problem. A small amount of time invested
with Risk Management will yield the necessary
tools to move forward, mitigating unnecessary
risk for both the practice and the patient.
STEP 5 - COMMUNICATE RISK
MANAGEMENT RECOMMENDATIONS WITH THE MANAGEMENT
TEAM
Once Risk Management has provided guidance and suggestions, it is important to review
them with the stakeholders. Consistent messaging and management of the patient cannot
happen without all parties understanding and
following the plan. Once a consensus has been
reached it is time to sit down with the patient.
STEP 6 - COMMUNICATE WITH
THE PATIENT
It is of utmost importance to remain
calm, consistent, and appropriate in your

LANCASTER

PHYSICIAN

communication. Anticipate the patient becoming upset and exhibiting the inappropriate
behaviors to be discussed. If possible, this
should take place in person and include two
representatives from the office, preferably the
provider and office manager. Express understanding that the patient is not fully satisfied
with the office and encourage the patient
to share specific frustrations or barriers. If
appropriate, communicate steps that will be
taken to address the patient's concerns. The
conversation will then transition to specific
behaviors exhibited by the patient that must
stop immediately and any future consequences
should the behavior continue. The goal is for
this to be a calm and respectful interaction. At
the end of the conversation, notify the patient
that a follow-up letter will be sent, outlining the
conversation and including potential changes
to be made by the office and expected changes
in patient behavior and consequences if the
behavior continues.
STEP 7 - BE CONSISTENT
MAINTAINING BOUNDARIES AND
EXPECTATIONS
Possibly the most difficult aspect is maintaining the set boundaries. The patient should
again be able to communicate with all staff
members. It is imperative that all staff report
the return of inappropriate behaviors immediately to allow leadership to follow up with
the patient. If the patient continues with the
outlined inappropriate behavior, it will be
necessary to implement the previously stated
consequences. If this is the case, it is recommended Risk Management again be consulted.
Addressing inappropriate behavior can be
complicated. Balancing patient care, showing compassion, and maintaining a healthy
environment for employees can be a delicate
balance. An organized, rational, collaborative approach will help facilitate the desired
outcome and hopefully improve patient
communication and satisfaction as well as
employee morale.
If at any time during this process there is
concern for any party's safety, law enforcement
or Crisis Intervention should be contacted
immediately. At no time should anyone's safety
be jeopardized.

Lancaster Physician Spring 2021

Table of Contents for the Digital Edition of Lancaster Physician Spring 2021