Doctor Patient Relations

Manage Angry Patients: Avoid Lawsuits

By Pamela Miller, OD, FAAO, JD

Angry patients sometimes initiate lawsuits. Lessen risk to your practice by responding appropriately when problems arise.

Most ODs pride themselves on treating patients with care and trying their best to ensure patients stay safe and comfortable. But, sometimes, even the most well intentioned doctors experience the wrath of an angry patient. The key to handling these situations properly is twofold. First, do everything you can to prevent potential problem situations; and, second, respond in a way that defuses rather than inflames the situation. As with all legal matters, it is always best to consult with your own attorney and state optometric board before taking any action.

You Are Responsible for Your Staff’s Words and Actions

Years ago, when I was out of town at a meeting, I called my office to check in and received an unwelcome surprise. One of my staff members told me that she was quitting because she just told a patient to go to hell. The employee knew, based on our office manual, that treating a patient that way was grounds for immediate dismissal, and, so, was beating me to the punch by quitting. But her departure didn’t mean I could go back to enjoying my meeting and casually address the issue when I returned. I booked a flight home immediately.

The reason I addressed this situation immediately rather than waiting a few days was that as practice owner, I am responsible not just for my own actions but for the actions and words of my staff, as well. That angry patient could go on to tell her story to friends and family damaging the reputation of my practice and could even sue. Remember, a patient can bring a lawsuit about nearly anything. They often have little chance of winning, but the last thing you need is to tie up practice resources in petty disputes.

The way I handled the situation: I reached out directly to the patient and apologized for the staff member’s words. I made sure before I finished speaking with the patient that their temper had been calmed. In addition to wanting to limit the damage to my practice’s reputation, I know that patients are less likely to create legal troubles for a person or a business they like. I wanted to make sure the patient left our conversation with a good feeling about my practice and understood that the staff member had been dismissed and was not representative of our commitment to patients.

Apologize and Remedy with Replacement Product

Have you ever had a person come into your office and ask for a frame repair on rickety eyeglasses? The problem is that their eyeglasses are hanging on by a thread so that your staff risks breaking rather fixing them if they attempt a repair. Complicating the matter is the patient’s very high prescription and the fact that these are their only eyeglasses. Knowing the individual would be disabled without their eyeglasses, the best thing to do is to kindly explain that you are worried about attempting a repair due to the condition the eyeglasses are in.

If the patient won’t hear of it and your staff member decides to go ahead and attempt a repair and the eyeglasses end up breaking, your staff should apologize even though they don’t see it as their fault: “Mr. Smith, I’m sorry, I tried my best, but as I feared, your glasses have broken. The good news is we can have a replacement pair of eyeglasses at no cost to you by the end of the day. I can put them in a temporary frame and remake the glasses for you. There will be no charge for this replacement pair.” Of course, it may simply not be appropriate to replace the patient’s prescription at no cost for any number of reasons, so each case must be handled on an individual basis. The best solution may require a new exam and prescription, only replacing the frame under warranty, etc. If the patient has vision insurance, that may help mitigate the problem as well.

Public Property Dangers to Your Patients:
What Are Your Options?

How is the sidewalk or street directly outside your office’s front door? Is there a potential danger like an uneven sidewalk that you constantly must warn patients about? It is your city’s responsibility to repair.

Contact your city’s manager to put in an initial request, along with the appropriate city department head. If there is no resolution, send a certified letter to the city and city council or mayor, citing the problem, potential harm to the public and a request that the problem be repaired in a reasonable time frame. Consider also addressing the city council in an open session.

If the city does not respond or make the repair in your specified time frame, then send a second and final notice, stating that if a response is not received or the needed repair made, that you will make the necessary repair yourself to ensure the safety of the public. Let them know that you will be billing the city for the needed repair.

Remember, making the repair may require a permit; the city may file charges against you for doing the repair and you may be liable if the repairs are done incorrectly or create a further safety issue, as well as for any injuries suffered.

Beware of Slips and Falls

Experiencing an accident during an office visit is likely to be a source of deep anger to patients, and a source of a potential lawsuit. In addition to considering all the possible hazards to patients in your office such as uneven flooring and unexpected steps up or down, make certain that both you and your landlord have the premises or office insurance (in addition to your practice liability) to cover accidents that occur in your office. You also need to be sure you have considered the dangers in the area outside your office. For example, my office is in an old Victorian house with an uneven sidewalk in front, so I always warn patients to be careful, and if a patient is unsteady on their feet, I have a staff member help them into and out of the office to avoid falls. If an injury occurs on the sidewalk outside of your office, you still could be named in a lawsuit.

I always tell patients who are older or who have a disability that we will do our best to help them into and out of the office, but that they also need to be careful. Warning them is essential so that if an accident occurs, you will be able to say you did everything you could, which includes any necessary repairs.

If An Accident Occurs…

The first rule if an injury has occurred is to call an ambulance and to train staff to call an ambulance if you are not in the office at the time of the accident. If no injury has occurred or if the patient has been injured and refuses to go to the hospital, it is still your responsibility to follow-up. If the worst occurred and the patient needed to be checked into the hospital, be sure to visit as soon as possible and ask if there is anything you can do. If the patient simply went home following the incident, give them a call and see how they are doing. You need to follow-up even if they bounce up from the fall and bound away seemingly in no pain. You want to show, first, that you did everything you could to prevent the accident (via a record of repairs to the office and warnings to the patient of potential dangers) and, second, that you did everything possible to remedy the situation once it occurred.

Beware of paying hospital or other related bills as doing so could be seen in a court of law as an admission of liability. If an injury occurs, you will need to notify your insurance company too.

Discuss General Health Issues Tactfully

A few years ago, I had a mother and son in my exam room. The son was obese. After reviewing my findings from the examination of his eyes, I decided to address the issue of his weight. With obesity a risk factor for conditions that affect the eyes such as diabetes and hypertension, I felt this was my responsibility. I asked the mother and son what they were doing to get the boy in better physical shape. I pointed out the importance of working with their family doctor to come up with a diet and exercise plan to get him in shape as being overweight was a risk to the child’s overall health–including his vision.

After the mother and son left my office, I got a call from the child’s father incensed that I brought up the topic of his son’s weight problem during his exam. He accused me, in so many words, of exceeding my scope of practice by discussing the boy’s weight. I explained to him why he was wrong and how the child’s weight could affect his vision: “As you may know, there are many factors associated with weight that can affect the eyes such as diabetes, high blood pressure and high cholesterol.” Using the phrase “as you may know” is more respectful than speaking to the person as if they are ignorant. Unfortunately, the father remained unconvinced and I no longer see the family in my office.

Any time you need to address an issue such as obesity that many patients may not realize is related to their eye health, it is best to explain upfront why you are discussing the issue. If the patient or a parent objects, hold your ground–you are not exceeding your scope of practice to advise them to work with their internal medicine or family doctor to address the problem.

Monitor Online Reviews–and Consult with an Attorney When Necessary

Most angry online reviews can be assuaged by directly contacting the patient, apologizing for their dissatisfaction and perhaps even offering something like a discount on their next pair of eyewear or contact lenses. It is important to respond directly and in a timely manner online. Apologize, offer to make it right, etc., but make sure you at least respond in a positive manner and directly address the issue. That allows those who are reading the review to see that you are responsive and fair. But there are times when you should consult with your attorney. For example, it’s one thing for a patient to write a review pointing out the lack of attention they received in your office or how they were left unhappy with their purchase, but it’s another when they make defamatory statements. For instance, if you notice a review accusing you being “a drunk” or of misconduct such as causing injury to a patient, consult with your attorney before responding.

It is worth taking the time to be careful and safeguard your practice before engaging in a casual back-and-forth when issues that threaten your licensure arise or you become involved in name calling, etc. And never respond to a patient’s post by using obscenities or defamatory comments.

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Pamela Miller, OD, FAAO, JD, DPNAP,has a solo optometric practice in Highland, Calif. She is an attorney at law, holds a therapeutic license, is California State Board-certified and glaucoma-certified to prescribe eye medications, and offers comprehensive vision care, contact lenses, visual therapy and low vision services. To contact her: drpam@omnivis.

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