Dealing with Time-consuming Patients at Your Medical Practice

What do you do with a very needy, very time-consuming patient? I don’t mean a medically complicated patient, who needs a lot of time spent during visits, or one who needs a lot of tests or prescriptions, or even one who needs a lot of counseling about his disease. I mean the patient who calls five times to 10 times a day, leaving 10-minute messages each time. The same one who will stand at the front desk for half an hour after her visit has concluded.

Case in point: I have a patient who has very well controlled diabetes on one oral medication. She has no complaints when she is here, but she does have a hundred questions. No, I take that back. Not a hundred questions. Just one or two …that she asks a hundred times; questions that have been answered repeatedly during previous visits and during in-between-visit phone calls. Simple enough questions, like “Do you want me to take more medication?”

I have tried to be patient with her, but I hate to have other patients wait, so I have unfortunately taken to just saying, “Your visit is over, I’m going on to the next patient.” Then she sits in the exam room for another 15 minutes still talking, to no one in particular. Then she goes to the front desk and starts talking to the staff, asking them the same questions she asked me. Then she’ll sit in the waiting room for another half hour. It makes other patients uncomfortable. It takes up the valuable time of my staff. Now this past week, she has called every day, a minimum of three times a day (one day 8 times!). My various staff members have talked to her, I have talked to her. And just like her visits, these phone conversations have no end.

I would not mind (well, maybe I would but not much), if there were pertinent issues, if she had a complicated case and needed a lot of medical attention. But she really doesn’t. As a matter of fact, I don’t even think she needs a specialist. I have tried (OK, selfishly) to tell her that she can follow up with her primary-care doctor and that she doesn’t need to see me, but she wants to.

And before you say, "poor woman," you should look at it form her point of view. You might be thinking, "Maybe she’s scared or confused." I’ve already done that, okay? Her first few visits and phone calls, I was patient with her. I gave her as much time and attention as I could. But just like an ER has to tend to more urgent patients first, so do I. And a pregnant woman on an insulin pump with an Hba1c of 11 or a man just diagnosed with thyroid cancer need more time and energy than she should.

I have called her primary-care physician to express my concerns about her ability to care for herself. I worry that this is all a manifestation of dementia or mental illness. I don’t know what else to do from here. I am at a loss - both from a time management standpoint and a patient safety standpoint.

How do I get her to stop calling? How many times do we have to call her back? How do I kick her out of the office when she is here? How do I do any of that and not worry that this time maybe there is actually something wrong?