When Service Recovery Fails

What if the doctor/patient relationship is no longer functional for either party? There are several circumstances where dismissing a patient is considered the appropriate action, for example:

• Non-compliance with the recommended treatment plan, and communication to remedy the compliance or potential issues causing the non-compliance have failed.

• Abusive language and behavior.

• Repeated no-shows and social determinants are not the cause.

• Failure to make payment on the bill after attempts were made to reach a financial solution.

Being faced with formally discharging a patient from your practice requires that you follow the specific guidelines published by the state medical board as well as your medical malpractice company. The basics are standard and include:

• Notify the patient with sufficient notice for them to find another provider, generally 30 days.

• Notification should be with two letters; one sent Certified Mail with Return Receipt Requested and the other via regular mail.

• All efforts should be made to make the patient’s medical records readily available to them or to their newly designated provider, assuring you have a signed record release form.

Holding transparent and open discussions with the physicians about the practice mission, code of conduct, and a service recovery program can hopefully yield a more positive strategy and plan for working with difficult patient situations to avoid unnecessary patient terminations.

My mother was right. We are judged by the company we keep. Please ensure your outside referrals are worthy! Your name and reputation are identified with every physician that you refer patients to for further care. Please be sure practices are the same as they represent themselves to be. Patients will not often tell you, but a not-so-pleasant visit to a provider that you recommend may also transfer to their opinion of you.

As an administrator, I have only had one phone call from a patient, and the concern was more about making sure that we know issues about the office she was referencing rather than concerns for her health. This is not a good reason to call because our patient’s health should always be the primary concern for any conversation. We had let this patient down. Fortunately, we had a great relationship with the patient, so they knew something must be off. That is so unfortunate on so many levels.

Of course, we apologized deeply, expressed how grateful we were for her call, and then referred her to a different office. We also followed up to make sure she was happy with that physician.

Because we have patients, not clients or customers, and we are not working on a piece of equipment to be repaired, patients may not be in the best mood. We deal with a bundle of emotions, and it is our job to read between the lines of what the patient is saying. Our awareness of the person’s emotional state is more than essential. We listen, respond (not react), and resolve the issue with a balanced and positive resolution.

Excerpted from The Emotionally Intelligent Physician Leader by Susan Childs, FACMPE.