Abusive Patient Behavior: Physicians Have 'Rights' Too

I recently received an e-mail from a primary-care physician who complained that her patients often demand she refer them to multiple subspecialists, even if she did not agree to such a recommendation. The physician further complained that when a patient does not get what he or she is “shopping for,” they often become verbally abusive to the physician and staff. Finally, she wondered: “Why is there no Doctor’s Bill of Rights”?

First, let’s discuss abusive patients. People can be abusive, and this is true in no matter what industry you work. Some people learn to deal with others in an aggressive or hostile manner as a means of getting what they want. Others are abusive when feeling frustrated or mistreated. Some patients are simply rude and abusive to everyone they encounter! Dealing with abusive patients can be challenging for a medical practice. When someone is acting in a manner where the practice staff fears for their safety or that of the patient, or the patient is disrupting the entire practice and refuses to leave, the police should be called. If someone is simply irate and/or upset, talking privately (it does not need to be the physician) with the individual is always the best option.

Diffusing a difficult situation with a patient requires that everyone remain as calm as possible and avoid raised voices or threats. Try to create a plan of action to address the patient’s issues or concerns or at least inform the patient that the issue will be reviewed so as to obtain time to speak with a legal advisor. Once the patient has departed, the practice can then consider if the relationship should be terminated-a process I have covered in previous blogs. The physician should also consider whether a mental health referral or other intervention is appropriate for the particular patient.

Although there was a “Doctors’ Bill of Rights Act of 1999,” which addressed a physician’s rights with regard to fraud investigation and enforcement by the government, no such formal “Bill of Rights” appears to cover the rights of physician with regard to how he or she is treated by patients and others.

What type of provisions would be appropriate to include in a Doctor’s Bill of Rights? Based on the many e-mails I receive from physicians, I propose the following:

1. Physicians have a right to be treated with respect as a professional.

2. Physicians have a right to practice medicine in the best interest of the individual patient and not in the best interest of an employer, insurance company, or other third party.

3. Physicians have a right to practice medicine in a way that best evidence and experience suggests, as opposed to being forced to make decisions based on cost containment, third-party interests, or the demands of patients for particular medications, treatments tests, or referrals.

4. Physicians have the right to expect that their services will be promptly reimbursed and that they will be paid fair market value for their services.

5. Physicians have a right to terminate a relationship with any patient who’s abusive (including yelling or threatening physicians, staff, or others), who fails to follow directions or who does not pay for/make arrangements to pay for services.

There undoubtedly are many other rights which physicians might want to include in such a “Bill of Rights.” Physicians can and should establish their own Bill of Rights for their practice to be distributed to patients. This will provide patients with a clear idea of what conduct will not be tolerated and may lead to termination by the practice.

Like any service industry, there are always positive and negative aspects of working with the general public. Physicians should remember that they cannot control the behavior or choices of any other individual, but everyone can choose his or her response to a situation. By having proper guidelines and a process in place for handling patients who do not meet the standards or rules of your medical practice, you can live within your own “Bill of Rights.”

Find out more about Ericka L. Adler and our other Practice Notes bloggers.