The scales: A metaphor for managing difficult patients

I was to see a prominent federal judge in my office at 9:00. The judge requested the first appointment of the day and expected to be seen promptly at 9:00. I had an emergency providing care for a patient in clot retention. As a result, I was not able to see him at the designated time. At 9:15, he approached the desk and asked when he would be seen. The judge was told that I was taking care of an emergency, and he said he couldn’t wait any longer. He left and asked for a copy of his records as he was going to make an appointment with another urologist.

I waited twenty-four hours and called the patient. I suggested that we have a meeting. He agreed to my suggestion and came to the office.

I accompanied him to my private office. I sat on the same side of the desk with no barriers between us. I turned off my cell phone and told my office that I did not want to be interrupted.

I started the discussion by stating that I had seen him approximately fifty times in the past thirty years. I mentioned that I was always saw him at the designated time of 9:00. I also would contact him within twenty-four hours to report his PSA test results. I reminded him that when he needed medication samples, I or one of my staff brought the medication to his office or his home. I brought to his attention that when he needed an urgent appointment, he was always worked into the schedule.

After reviewing our history together, I raised the palms of my hands to simulate a scale. I said, “If you put my history of providing care for you on a scale, would you agree that all the positive interactions that we had outweighed the one time I was unable to see you because I was managing an emergency patient?”

I then placed one hand at the same level as my head and the other one below my waist to demonstrate the disparity between what I had done on his behalf versus the one time I could not meet his needs or demand.

I paused and waited for his answer. He said, “I agree that your attention and services offset your singular mistake.” Although I disagreed with his use of the word mistake; I did achieve my objective of getting my point across. We were back on the same page, and his anger and hostility were reduced.

This metaphor with the scales certainly worked with a judge who understands the concept of scales and justice. I have used this metaphor professionally with other patients, family, and friends who are critical of me for an error.

Does this always work? Of course not. However, this metaphor puts into perspective that the positives outweigh the negatives.

Bottom Line: You can’t make everyone happy all the time. However, as physicians, we can please patients with the care we provide them most of the time. If we use the metaphor of the scales, they can visually see our point of view. We can emphasize that one problem should not affect the entire relationship. So, lift up your hands and use the scales to demonstrate that we do an excellent job caring for our patients.

Neil Baum, MD, a Professor of Clinical Urology at Tulane University in New Orleans, LA. Dr. Baum is the author of several books, including the best-selling book, Marketing Your Medical Practice-Ethically, Effectively, and Economically, which has sold over 225,000 copies and has been translated into Spanish.