How to Deal with Disappointed Patients

A few years ago, my father was diagnosed with metastatic cancer. Today, after all his rounds of chemotherapy, he still has cancer. At first, he was disappointed that his cancer was not cured. He now understands his cancer is contained and his life has dramatically shifted. When he and my mom discussed their disappointment with their physician, they were very satisfied with his answers.

My father, who isn't particularly outgoing and touchy-feely, noted that the doctor took the time to listen to and answer all of their questions. He told me, "Dr. Blake understood me." I asked my father how he knew Dr. Blake understood him. He replied, "He asked me questions before I told him what was going on. He showed me he knew what I was going through." My dad said Dr. Blake said things like, "It sounds like you are feeling …" and "It appears you're upset and frustrated about …." My father would confirm those feelings and Dr. Blake would share his thoughts on the matter and ask a follow-up question.

My dad left the office disappointed and satisfied. Disappointed he was not cured, but satisfied that his doctor cared about him and had done all he could. All it took was five extra minutes, starting with the person, and demonstrating he was connecting with my father.

Dealing with a disappointed patient is always challenging. Some physicians do not want to deal with them. They might minimize these patients or avoid addressing the issue altogether. Avoidance and minimization never solve problems. Rather than avoiding these issues, here are some tips for dealing with disappointed patients.

Identify the Problem

Your patient is disappointed. Do you know why? What event happened that led to their disappointment? What assumptions do you hold as you assess the situation? Do you understand what their expectations were? I suggest you approach patient encounters with a blank slate. Walk into the conversation with an open mind. Recognize you don't have all the answers. You might have the answers regarding the best therapy for a particular diagnosis, but you may not have all the answers as it relates to how your patient currently feels. The first step in dealing with a disappointed patient occurs before your conversation with them begins.

Separate Problems from Baggage

Too often when we deal with people and issues, we bring along our personal experiences. These experiences are valuable. In fact, most of our medical practice is based on past experience. We can cite cases we've seen that we use to justify our clinical decisions. But when we deal with people, we mustn't let our past experiences cloud the nonclinical issues. We need to separate the real problems from the baggage.

Baggage are our life experiences that we use to construct our world vision. Sometimes the baggage helps, but it can also hinder us. Everyone has baggage, and your patient is carrying baggage with them as well. Perhaps they've had bad experiences with physicians. Maybe those past experiences have led them to believe all doctors are short on time and compassion. They might, unfairly, apply their world vision, created by their baggage, to you. That's okay because you've considered their baggage before you start the conversation. Beware of the baggage you carry too. It can hurt how you perceive people and their problems.

How to Find the Problems

Doctors must keep in mind patients have both clinical and nonclinical problems. The best way to stay focused on finding the real problem with your patient is to remember your what and why. What is it you're trying to help them with and why are you doing it?

You might want to get their blood pressure or diabetes under control because you want them to have a long and disease-free life. That's the clinical side. There are also nonclinical problems our patients face. Perhaps they don't fully understand how to take their medicine, or they cannot afford it. Maybe they don't have the support they need at home to manage their disease. They might be disappointed in their treatment for reasons that are outside of your control. Your job is to discover where those problems are.

Approaching Them as a Person

We as physicians get so focused on the task - doing things, watching numbers and trends - that we can forget the people we are treating. A mentor of mine shared some excellent advice with me, and it has helped tremendously during my career. He said, "Always start with people, then move to task. You might not need to spend a lot of time focusing on people, but you need to invest a little time doing it. Otherwise, whatever task you want to accomplish will be in jeopardy."

Starting with people is easy. Just acknowledge their humanity, emotions, fears, and needs. Once you do that, their defenses and barriers will come down. If you jump right to the task as soon as you enter the room, you'll come across as cold and uncaring. You will need to move to the task at some point, but don't rush there if time permits. Most people only need a few minutes of you focusing on them to make them feel comfortable.

A Tool for Connecting

I'm a fan of an FBI hostage negotiator Chris Voss. In his book, Never Split the Difference: Negotiating As If Your Life Depended On It, he describes a tool called labeling. It's a great way to build empathy and the people connection. You directly label the emotions and feelings the other side is showing. "It seems like you're …" and "It sounds like you're …" are great ways to label the emotion the patient is demonstrating. Labeling will have an excellent effect of connecting with them on an emotional level by showing them you recognize the importance of their feelings.

In Conclusion

Once you've dumped your baggage and assumptions, approached patients with humanity and compassion, and discovered the real problem, what's your next step? That depends upon what the real problem you discovered is. Is the problem something that is your fault or one you can solve? Did the patient have expectations that weren't correct? Have an honest and forthright discussion with them. If you can do that, you'll be getting thank you cards from your patients for a very long time.