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Providing quality health care involves developing trust and rapport between doctor and patient. The ability to communicate with your patients in an open and honest manner is perhaps the most powerful management tool you can use. There is a growing body of research indicating that effective communication plays a key role in the prevention of complaints and litigation.
The practitioner's verbal and non-verbal communication style and skills influence the patient's perception of the quality of care. As patients may not necessarily have the knowledge to enable them to judge a practitioner's clinical competence, the patient's assessment of the service delivery provided could be used as measure of your competence.
An important precursor of dissatisfaction is inadequate or inaccurate information and communication. In general, if the relationship between a doctor and patient is strong and an adverse event occurs or a patient's expectations are not met, patients are less likely to be dissatisfied with your care and more understanding of the outcome. Research indicates that the patient who feels abandoned in these circumstances is the one who is more likely to complain or commence an action against the practitioner.
Patients expect that the doctor will provide them with:
Anger and frustration are major drivers of complaints, with patients making statements such as the below:
Building an atmosphere of mutual respect will assist in the event that something unexpectedly goes wrong. If there is effective communication with the patient it will assist in dealing with, and resolving, the situation at hand.
Doctors who recognise that some patients or situations are more difficult to handle than others should consider attending one of the range of communication workshops that are offered through their college or other organisations. Effective doctor-patient communication strengthens the trust that is established with patients in serving their health care needs.
If a practitioner can determine that a patient's expectations have evolved from one of the above factors, then they can focus on where the discussion needs to be directed.
Learning to become an effective communicator does not always come naturally to practitioners or their staff. It is not always an easy task particularly within the challenging and demanding environment of a busy medical/surgical practice. There are some techniques that can be useful to facilitate and encourage an enhanced relationship with your patient.
First impressions count
Getting the 'front end' right should be part of every management plan for you and your practice. Patients start formulating their opinion about the practitioner from the moment of first contact. This opinion is based on the entire 'cycle of service' which encompasses:
The 'cycle of service' should be viewed from an overall perspective of practice staff contact, products/services and processes/systems that support the core business - the medical
Familiarise the patient with your practice
The moment the patient phones or attends your rooms to make the initial appointment is the ideal time to familiarise the patient with your practice.
Provide new patients with written information in the form of a pamphlet/brochure that familiarises them with your practice. This can assist in avoiding misunderstandings, unrealistic expectations and complaints about 'service'. You might include the following:
Apologise to your patient if you are running behind for their scheduled appointment.
Listen to patients and respond to their needs and preferences.
Respond to patients in a way they can comprehend and understand.
Acknowledge their situation or concern.
Use silence effectively, allowing patients enough time to express thoughts or feelings.
Ask the patient questions and invite them to ask you questions, ask their opinion and seek their expectations. Ask the patient to repeat to you what they have understood of your discussion.
Don't make the patient feel rushed. The last thing a doctor should do when pressed for time is to behave as if pressed for time. The patient is more likely to leave the consultation with 'unfinished' business.
Explain what you are thinking and openly discuss your proposed
management and treatment plan. Patients about to undergo a
procedure should be informed what to expect during and after
treatment. Consider the following examples:
Provide the patient with options and the time to consider them. Determine the patient's level of understanding by using a questioning strategy that will allow you to identify any deficit in this regard.
Complaints handling systems
Avoiding complaints would be the ideal, however the reality is that you will probably encounter a complaint at some time in your professional career. It is important to have a protocol in place for handling complaints and for dealing with them promptly and professionally.
Managing patient expectations
Doctors can be drawn into arguments and then give in to patient demands "because they felt sorry for them" or wanted to "do them a favour" or just could not say "no", against their clinical judgement. In the long run, this places a great deal of strain and pressure on the doctor and sets up the patient's expectation for treatment in future consultations. For instance, there are limits to what medicine can achieve: some illnesses cannot be cured, advertised medications or procedures may not be suitable for a particular patient, or a cosmetic procedure may not restore a patient's happiness.
Managing unrealistic expectations is about assessing the situation and thinking about points such as those which follow:
Sometimes a patient's behaviour may concern you. Not only is this a challenge to deal with, but staff and waiting patients may find it distressing. It is important to set limits and boundaries and no matter what the cause, you and your staff should not tolerate unacceptable behaviour. You may refuse to deal with a patient until they have calmed down and are prepared to speak reasonably to you. In extreme cases, you may be required to send them away or call for help from staff or the police. Avant's Medico-legal Advisory Service can provide further advice in relation to these situations.
Dealing with 'difficult' patients
It is easy to label a patient as 'difficult' because they express anger, hostility, are demanding, have unrealistic expectations, are not likely to be compliant, are 'doctor shoppers'
or have had repeated procedures for the same problem.
While you are within your rights to refuse to treat that patient, it is important to establish the reason behind the patient's behaviour before deciding to decline to manage them. An
open and honest approach is the best way to gain the patient's trust and they may be more likely to tell you what is going on.
There are some patients who may continue to be disruptive and non-compliant despite all the measures you take. You may feel that you are not the right doctor for them and that they would be better managed by someone else. However, there are some situations in which you cannot make this choice. These include:
Practitioners cannot deny access to their practice solely on the
basis of race, ethnicity, religion, HIV status, sex or any other
reason which falls under anti-discrimination legislation.
If a patient has been referred to you and you decide you do not
want to manage this patient, it is best to refer the patient back
to their referring practitioner rather than suggest another
practitioner. This will ensure you maintain good relationships with
your peers by not referring 'difficult' patients, and also keeps the
referring practitioner informed.