How to Create a Disgruntled Patient

In most circumstances I strongly prefer to state advice positively, e.g., what one should do as opposed to what one should not do. Sometimes, however, the negative provides useful context. Here is a message you, or your staff, should never deliver (explicitly or otherwise) when dealing with a patient:

"Our office is understaffed, disorganized, and/or undisciplined, and we are making that your problem instead of ours."

Here are some variations on that basic theme:

1. "We are too busy to do that."

Sometimes this is a statement of fact, albeit graceless. It is much more palatable to the patient to say what can be done in response to a request. For instance, when a patient appears with an insurance form and wants it completed while she waits, you can say:

"We have a full clinic today. I'll be able to work on your form between patients and will have it completed and signed by 9 a.m. tomorrow. If it's ready sooner, I'll call you."

More often, staff manifests a lack of understanding of the patient's role as customer and guest. An apt example is the office of a chronically late physician that is too busy to update patients on the status of the schedule.

2. "This is what you need to do."

I am not talking about telling a patient he needs to eat less and exercise more to reduce his weight and enhance his health. Neither am I talking about fail-safe advice like: "If we have not called you with the results of this test by Tuesday, please call us."

What I am talking about is burdening patients with work that rightly belongs to the practice. A recent appointment I had with a physician at his satellite office required a follow-up at the main office. The satellite office made the second appointment, but asked me to call the main office to confirm it. Apparently there are frequent failures in communication between the two offices. It turned out to be good advice because the appointment had not made it to the book at the main office.

3. "Someone takes messages and doesn't pass them on. We don't know who it is. If I don't return your calls, please feel free to keep calling."

I heard a nurse say this to a patient last week. Let's unpack the message:

• At least one person in our office is unreliable.

• We know it involves phone messages. We have no idea what else may be falling through the cracks.

• We cannot figure out who the offending staff member is. Or, we have not even tried to figure it out.

• It's not my fault.

• You are well-advised to keep calling until you make a connection

• Don't feel bad about calling multiple times. It's OK. You are not bothering me.

If the patient processed the unstated message, he is probably looking for a new doctor. He should be. As irritating as unanswered phone messages are, the more important issue is what the known lack of discipline says about the quality of the practice's patient care.

Physicians are at a disadvantage in managing the messages delivered by their staff members, because they are seldom there to hear it. That is why it is particularly important for them to regularly talk with staff about both appropriate and inappropriate responses to patients.