• By Leslie Burling-Phillips, Contributing Writer
    Interviewing Hans Bruhn, MHS, and Elise Levine, CRC, OCS
    September 2011


    Despite your best efforts, you will never be able to please all your patients all the time. Although you can take steps to identify and prevent the most common types of complaint, you won’t be able to prevent them altogether. And when a patient does have a grievance—if your practice doesn’t handle it skillfully—a minor incident can easily escalate into a major issue.


    An Ounce of Prevention

    All patients have the potential to complain, but by “managing expectations from the outset, you can avert many complaints,” said Elise Levine, CRC, OCS, practice administrator and director of clinical research at North Valley Eye Medical Group in Mission Hills, Calif.

    Know your patients’ needs. “Take time to learn about your patients,” said Ms. Levine. “Identify their unique needs and accommodate them accordingly whenever possible.” Ms. Levine described a common scenario and solution: “Patients who work in certain professions have very specific needs. Make sure your opticians are aware of the special requisites for airline pilots, engineers and computer programmers, for example. Local labs can meet with your optical staff to discuss special lenses and measurements to accommodate these patients, which can prevent the necessity for a redo.”

    Explain why you’re behind schedule. The majority of complaints a practice receives tend to center around patient waiting time, said Ms. Levine. Multiple issues can derail a practice’s schedule, resulting in longer-than-usual wait times. When this does happen, patients are likely to become increasingly impatient, even angry, if you don’t offer them an explanation for the delay or a gesture of appeasement (such as providing parking validation or an opportunity to reschedule).

    Help patients pass the time. To accommodate patients while they wait, North Valley Eye Medical Group installed flat-screen televisions in the waiting room, in the dilating areas and in each exam room. “We subscribe to a satellite provider so patients are able to watch whatever they want, which helps pass the time while they wait,” said Ms. Levine. She warned against using informational videos that loop and continuously replay. “Patients become acutely aware of how many times they have watched a video after it begins to repeat, which can increase, rather than alleviate, their displeasure.”

    Know which of your patients won’t tolerate delays. One way that you can reduce complaints about delays is by “scheduling anxious patients for the first appointment of the day or immediately after the lunch break,” said Ms. Levine.


    When Complaints Arise

    When patients do make complaints, how do you increase the odds of a positive outcome?

    Impart empathy. Your ability to convey kindness and respect is often “the one thing that will prevent a complaining patient from moving toward a liability claim when there is a problem,” said Hans Bruhn, MHS, senior risk management specialist with Ophthalmic Mutual Insurance Company (OMIC).

    Although your interactions with unhappy, possibly irate, patients won’t always be pleasant, you should avoid the temptation to limit or dodge those conversations. “Your receptiveness and responsiveness can be pivotal, particularly when a poor outcome is involved,” he said. “Patients want to know that you care about them and are willing to help.” The worst approach you can take when you receive a complaint is inaction.

    Establish protocols. “Too frequently, practices do not have defined procedures for addressing complaints,” said Mr. Bruhn. Regardless of the size of your practice, you will benefit from having a formal policy in place for identifying and resolving complaints. If, for example, your procedures include guidance on monetary responses—such as giving discounts in the optical shop, paying for parking or writing off a balance—then this can empower your staff to act quickly and nip many problems in the bud. Your protocol should therefore identify typical scenarios in which your practice is willing to offer those types of responses, establish who has the authority to approve them and create a formal process for staff members to follow.

    Rely on your staff. It is essential to employ a staff that you can trust to resolve issues effectively. Everyone who works in a practice should be equipped to tackle complaints rather than automatically passing them along to a supervisor to resolve. “It goes back to the ‘teach someone to fish’ adage,” said Ms. Levine. “I do not want to be involved in settling most complaints. Part of coaching my staff is teaching them how to resolve issues. When they come to me with a patient’s complaint, I also want them to propose a solution. Sometimes they are spot on, and sometimes it becomes a learning tool to help them identify alternative methods for assisting a patient.”

    Understand the patient’s bottom line. “Complaints tend to occur more frequently when out-of-pocket expenditures are involved,” said Mr. Bruhn. “This is particularly the case when a patient does not have the money to pay for treatment or medication. Inquire when you think a lack of financial resources might be at the crux of a complaint. Negotiate a payment plan if possible.”

    When to get the doctor involved. “There are very few times that our physicians actually have to get involved in complaint resolution. They prefer that, as an issue escalates, it escalates up to me,” said Ms. Levine. “Our patients know that I am speaking on behalf of the doctor, and I am usually able to defuse the situation. However, if I identify an incident that I think requires communication by one of our physicians, they are always willing to assist. The key is to make sure that the physicians are knowledgeable about the complaint so they can discuss it cogently.”

    When expectations aren’t met. Despite a rigorous informed consent process, not all patients are satisfied with treatment results. Similarly, patients may not accept their diagnosis. “Some outcomes, through no fault of the physician or staff, are poor or cannot be resolved,” Ms. Levine said.

    Mr. Bruhn agreed: “Without a doubt, ophthalmologists should deal with patients who are unhappy with the care provided. In part, patients may be dissatisfied due to their lack of understanding of the procedure or because they had unreasonable expectations. One common example is that cataract patients may expect perfect vision after paying for implantation of a presbyopia-correcting lens. In such cases, it is usually best that the complaint is referred to the treating physician for explanation and resolution.”

    Document incidents concisely. Creating a written record of events is the best way to protect yourself when a quality-of-care complaint develops, especially if a malpractice claim could be looming. This documentation enables you to have all the facts on hand rather than having to re-create a situation from memory, sometimes months or years later. A brief annotation in the patient’s file is sufficient, but necessary, even for minor complaints. For example, “if a complaint occurs prior to a patient’s exam, I ask my staff to note it in the chart,” said Ms. Levine. “Because agitation can cause elevated blood pressure and increased anxiety,” the technician and the treating physician should be made aware of the initial complaint in case the patient’s state of mind impacts the examination. Likewise, she said, “some patients display patterns of behavior that may give you reason for concern. Your staff should be intuitive and document any pertinent details.”

    “When allegations of malpractice are investigated, the first item an insurance company will try to confirm is that you have created the appropriate documentation,” said Mr. Bruhn, who provided some sample verbiage appropriate to include in a patient’s record: “On this date the patient requested his medical record. Patient was unhappy about charges and fees. The matter was discussed. A copy of the medical record was given to the patient. The patient terminated care with the practice.”

    Leave subjective comments out of your documentation. Subjective comments related to a possible liability claim should not be included in the medical record. “Contact the risk manager at your professional liability insurance company for guidance,” said Mr. Bruhn.