'Problem' Patients: Dealing with the Waiting Game

This is the first in a series of Practice Notes blogs about how to address issues with some of your more challenging patients. Trisha Torrey will also participate in a live question and answer session - more information here.

You arrive at your office, ready to take on your day. You hang up your coat, throw your stethoscope around your neck, and pick up a copy of your patient schedule off your desk, glancing down the (as usual, too long) list for familiar names.

And then you cringe.

Two or three of those patients have the ability to just ruin your day. From waiting room complainers (“Doctor, I SHOULD NOT HAVE TO WAIT for twenty minutes to see you! My time is valuable, too!”) to non-compliant patients (“I know I need to quit smoking, doctor, but what can you give me for this cough?”) to "Googlers" (“Just take a look at this three-inch stack of print outs of information I found online, Doc!”) – their requests and demands are irritating and draining.

You sigh. Another day of ups and downs - and major frustrations with this growing list of patients who just don't understand that you can't be the hand-holder they expect you to be. They don’t grasp the constraints on your practice that won’t allow you to spend large amounts of time, magically clear out the waiting room, or dissolve their lifetime’s worth of bad habits.

Does this sound familiar?

Frustration and aggravation are on the rise in practices all over the country. Further, as healthcare reform kicks in, and 32 million new people try to add themselves to your appointment roster, it’s hard to think the situation will improve any.

So what can you do? Is there a way to make this aggravation disappear? Or, are there steps you can take that would at least make some of these difficult patients easier to deal with?

For some of them, yes.

First, understand that you and your practice are “victims” of history. The shift in our healthcare system during the past 20 years makes it unrecognizable to most patients. They have spent a lifetime of leaning on their doctors for not just medical care, but some psychological support, too. When they are fearful or frustrated, facing a system they no longer understand, they don’t know how to get what they need.

Patients have a set of expectations that is unfulfilled, so they get frustrated and act out. As a result, we see higher rates of non-adherence, patients who spend far too much time on the Internet, patients who are simply dissatisfied with the help you can offer - even pain pill seekers who really need a guiding hand far more than they need another prescription.

There is aggravation, irritation, exasperation and dissatisfaction all around – for you, and your patients, too.

Over the next few weeks, we’re going to take a look at how one simple approach may help you eliminate some of this dissatisfaction. It’s a proactive approach that costs nothing, but can lead to improved communications and understanding. You’ll feel better about facing some of these difficult patients, and your patients will feel better, too.

We’ll begin with the waiting game.

Just like you have other responsibilities, patients do too. When they visit you, they are missing work, or need to pick up the kids after school, and so on. When they complain about waiting room time, what they are really complaining about is that you are taking away their own control of their time. That’s a very uncomfortable position to be in.

When you arrive at a very crowded restaurant , why do you ask how long the wait will be? Yes – so you can decide whether to stay, or go sit in the bar, or go to another restaurant. You want to control your own time and choices.

The same with the supermarket deli. You take a number and wait your turn. You then get a sense of the wait time, and decide whether to stay, or go pick up a few other items. You control your choices.

But you can give patients back some of that control by managing their expectations.

When patients arrive and check-in, have your receptionist provide an estimate of how much time they will wait. Make sure that estimate is five to ten minutes longer than the real wait time will be. Just like when you go to a restaurant, and you’re told how long your wait will last - when it’s shorter, you are happy. Your patients will be, too.

When you need to leave the exam room to find a nurse or retrieve a brochure – manage your patient’s expectations by telling him what you are doing and what will happen next. Otherwise your patient will sit there, anticipating the worst, having no idea where you’ve gone, or why, or whether he’s supposed to get dressed or ? Not knowing what to expect, or what is expected of him, he will become annoyed – and irritating to you or your staff. Relieve his mind by telling him what to expect.

Managing a patient’s expectations is a simple step, costs you nothing, but can have a huge impact on your day and your practice.

Next week, we’ll take a look at another problem patient – the "Googler" – and how you can improve your relationship and overcome your irritation with him, too.

Trisha Torrey is "Every Patient’s Advocate," the About.com Guide to Patient Empowerment, and author of "You Bet Your Life! The 10 Mistakes Every Patient Makes (How to Fix Them to Get the Health Care You Deserve)." She focuses on helping patients and doctors work more collaboratively to improve outcomes for all.

Have a "problem" patient of your own - now or in the past? Trisha Torrey will be participating in a live question and answer session on Friday, May 13 at 12 p.m. EST to discuss her Practice Notes blogs and take your questions. The event is free, but registration is required.

E-mail keith.martin@ubm.com by Thursday, May 12 at 5 p.m. EST to get your spot for this event.