As owners and/or managers of small business, optometrists usually think of firing in terms of how and when to fire an employee or associate. However, there are times when it is necessary and prudent to fire a patient. This is one of the most difficult tasks we encounter, and it is actually very hard to do.
As owners and/or managers of small business, optometrists usually think of firing in terms of how and when to fire an employee or associate. However, there are times when it is necessary and prudent to fire a patient. This is one of the most difficult tasks we encounter and it is actually very hard to do.
The joy as well as challenge of owning or managing a practice is that you are not only the boss, but you are responsible for every aspect of the office. A significant part of that responsibility involves growing the patient base. As anyone in practice knows, it is a difficult task at best, and it is one that never ends. Patients leave, move, or die. In order to maintain a balanced practice, they must be replaced with new patients. The value of a patient varies depending on the money they spend, the number of referrals they make, and the insurance they have. While all patients may be equal, the fact is that their dollar value is most definitely not equal.
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A successful practice needs an enthusiastic staff and a doctor who looks forward to coming in to a full day of patients, in spite of the daily problems that always seem to arise. Both staff and doctor need to be appreciated and even have fun amidst the daily bustle offered throughout the day in our practices. The magic that our patients bring to the office which makes the day go more quickly and brings laughter and fulfillment to our daily lives.
So what happens when we encounter the patient who physically and emotionally drains both our staff and us? We become irritable, we dread seeing the patient, and we now have both the emotional and psychological baggage that comes with knowing we are going to have a negative influence coming into the office.
Most of us just want to run and hide-just make sure we are not there or are very busy when that patient darkens our door. It sets a pall on the entire mood and atmosphere of the office, from our front office staff, to our chairside assistants to our optical dispensers, and ultimately to the doctor.
Sometimes, those are the patients who need to fired. Sometimes patients are so rude and disrespectful to staff and doctor that they need to be fired.
Fortunately, in the scheme of things, most of us rarely have to fire a patient. When we do, it is typically with a great deal of thought, some misgiving, and even trepidation. It isn’t easy to do, and there is almost some aspect of doubt that seems to linger at the back of our mind, even when all is said and done.
For the newer doctor in practice, it is very difficult to fire a patient. It takes courage and a strong degree of self-assurance. It also requires diplomacy and the ability to simultaneously address the concern at hand and support our office personnel. In short, we have to determine when we have had enough of the patient’s behavior to justify firing him or her, or even the entire family. It is a task that only the practice owner or manager can handle.
So how do we go about firing a patient? There are several methods, some better and more final than others. There are even patients we fire who return to our care (these are often the amazing ones, at least in our mind). Let’s look at our options.
1. Sometimes, patents exhibit bad behavior. They are nasty to our staff, they may be belligerent or rude. This is the situation in which the doctor should come right out and tell the patient, “I’m sorry, but we do not allow this type of behavior in our office. It is time for you to see someone else.”
The interesting aspect is how you handle this goodbye notice. By using a non-threatening tone and even apologizing, you can turn this patient around completely. You may say, “I am really sorry, we have enjoyed having you as our patient, but…” This patient may very well end up returning to the office and apologizing. Of course, your option may be to refuse to see him again, or perhaps to regard it as a learning experience. “Yes, you weren’t very nice to our staff, but I am glad to see that you are so much better this year.” In essence, you have acknowledged the bad behavior, acted upon it, the patient has reconsidered, apologized, and you have accepted the apology and moved on.
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Surprisingly, this person may end up being a long-term patient who may simply have been going through a very rough patch. It may be that the patient is going through bankruptcy, a divorce, has lost his job, may have had a stroke (which may result in uncontrolled swearing, or anger), or may have mental or emotional problems that are not medication controlled. A bit of understanding and patience may be in order for these special circumstances. We all have bad things that happen to us, and sometimes, we as healthcare practitioners need to remember that and try to minimize or ameliorate the effect on our staff, other patients, and our practice.
2. When a patient exhibits unacceptable behavior to the extent that you never want to see her darken your door again, a stronger measure is needed. This may be the patient who is threatening, who no-shows her appointments (despite your best efforts), who always complains about or harasses your staff, who always wants something for nothing or wants to bargain for a deal, who has children who don’t behave, and more. This patient is probably a lost cause, and no amount of trying to correct that bad behavior is going to succeed.
This is the patient for whom a more direct approach is appropriate. You may verbally dismiss the patient either by phone or when she is in the office, or find that a written note acknowledging the behavior or action is preferably. Be sure to follow up a verbal termination with a written letter.
You may use the same technique. “I am sorry that we don’t seem to be meeting your needs. I think it is time for us to part company so you can find another doctor where you feel more comfortable and your needs are being met. I will be happy to forward your records to another vision care specialist of your choice. Please let us know to whom you would like us to forward your records.”
The generic format often works best, rather than specifically calling the patient out. Simply acknowledging that you think the patient would be better served by seeing another doctor and that you will be happy to forward her records to the new provider should be ample. Of course, you need to keep a copy of the correspondence in the patient’s file. Should the patient call or show up to dispute your decision, then a brief discussion (in a quiet area of the office) should ensue. The patient must be treated politely and with discretion. Only the doctor should handle this encounter. Amazingly enough, there are even times, when after a civil and frank conversation, the patient will promise to do better. At that point, it is your decision as to whether to give the patient another chance, depending on the problem.
3. The third option of purposely not recalling patient or purposely having no open appointment slots for an inordinate amount of time is the coward’s way out. It is disrespectful and could end up creating a problem with the patient and even with his insurance carrier. This is the riskiest of behaviors and could end up creating an investigation into your office practices by the patient’s insurance company or even a legal representative. This could be construed as patient abandonment, which is definitely a potential legal concern.
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4. Of course, there is always the Donald Trump Method-simply point at the patient and say in a loud voice, “You’re fired!” While you may frequently fantasize about this option and that thought may even give you some personal satisfaction or even a chuckle, it isn’t the most prudent option to select. Such a move is almost guaranteed to create friction, tremendous disharmony, and potentially legal problems as well.
5. If you have a patient whom you no longer wish to see under any circumstances and he is covered by insurance, it would be best to let the patient know that you will not be caring for him in the future and he needs to see another practitioner. At the same time, offer to forward his health records to that doctor.
Concurrently, it would be prudent to notify the insurance company of your decision, along with the reasons for your decision. Be specific. This is not the time to vent your feelings, sense of hostility, or create any whiff of discrimination. Make certain that you have documented the bad behavior in your records (including dates, times, and witnesses). If your staff was directly involved or witnessed what occurred, that information should be included in your records as well (signed and dated by the staff person).
It is never easy to fire a patient. It creates a lot of angst and is more difficult if you are newer in practice. It is an act that should never be taken lightly nor done in anger. Firing a patient should be accomplished in a quiet setting where it is not seen or overheard by other patients. It requires a rational tone, hopefully tempered with kindness, empathy, and an understanding that you cannot please everyone, despite your best efforts. In fact, there just may be no pleasing some people, no matter what you do or say.
Nevertheless, the day will come when you will have to fire a patient. When you do, make certain that it is clearly documented in the patient record. It is your practice and you have the right to control who you see, what behavior is appropriate for your office, how you staff is treated, and how much chaos you will allow. The hardest part of being the boss, is just exactly that: being the boss.
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