Home Forums Discussions General Discussion Emotions of patient transfers

Been meaning to put this on the board for awhile. I was just wondering what reaction providers have when they receive release forms for a transfer to a local office.

I always think it would be nice if the parent or patient would tell you why they left for some closure and constructive criticism, but I know that is not realistic. I also don't think that patients understand that providers have feelings too and even have bad days.

No matter how much I try to rationalize it, I always feel hurt and angry after.

Any thoughts or advice on dealing with this. They don't teach this in medical school.

Bert,

A few thoughts on the matter:

If it is a rare event, you have a couple of options. You could blow it off and not take it personally. Afterall, if they are not happy with you, the relationship is no longer a good relationship and may open you up to liabilty (am I rationalizing now!?). Another option is to call the patient either personally(especially if you thought you had a close relationship) or have a staff person call (perhaps less intimidating). The problem here is that if they haven't given you constructive criticism so far, it likely still won't happen. A third option is to drown your sorrows with your favorite drug of choice (not sure if posting on the board counts Bert!), but I don't think that would be very constructive.

If this is a frequent problem for you, then you have major problems! (I doubt this applies to you Bert. The few docs I've seen who had patients leaving in droves didn't seem to be in the least bit bothered by it or blamed others....which explains their problems!)

In the end, I think it is a normal and healthy thing to feel something when a patient leaves, whether it be sadness or joy. I fondly remember the day one patient told me he was going to see another doctor after I wouldn't refill his narcotics! Our office happily had his chart printed and ready to go.

Don't know if this helped, but to quote the former president "I feel your pain"....or was he the one that said "where's my intern!"

Patients leaving my practice is a rare event.
However, when it does occur, I lose sleep over it.
Sounds like Bert and I have hypodermatosis atrophicus(thin skinned).

I usually have my office personnel to scout out to see if there were deficiencies in service or care. I think it's important to know if they are angry (as this may be my very last opportunity to intervene). Was there a bad outcome? (I need to know that!).

If there was something we should have done better, then I will call, apologize and see if there is anything I can do to keep their business. If I had enjoyed working with them, I would invite them to return if the grass isn't really greener on the other side. Usually these patient return after not being able to get an appointment for three weeks at a local hospital run Megaloclinic.

What is sad is that the patients that whine, bitch, moan, and are a pain in the a$$ never decide to leave the practice voluntarily.

Anyways, hope that's helpful.

Thanks both for the comments. I always wrestle either way. I used to call each time, but now I lean towards not calling. I guess I feel as though it can't help much as they will feel uncomfortable, and I will just aggravate my hypodermatosis. Maybe I just tend to think I give a very good brand of service and go out of my way to help them. I sort of think to myself, went out of my way to help them, and they still left. Which probably isn't fair. I do think that patients, in general, think that it is just a business for us and we do not have feelings.

In my last practice, I worked with another doctor. Fortunately, I was on the right side of the heart and more patients tended to flow toward me than the other way arond. Luckily, there was no pulmonary hypertension. On one side, it made perfect sense that a person would switch doctors if they were more comfortable with the other. On the other hand, comparing everything to the way I would do it, (again not so fair), I go to my own doctor, and I would never switch to another doctor in the same practice. I just couldn't look him in the eye.

Ironically, while it would be hard to hear the criticism on the phone, maybe because I would know it was coming, but I have no problem in the exam room. That is the ONE place I am able to listen to any and all complaints about me or my staff. I just wish every patient could do that.

Well....anyway...

Bert,

Remember this phrase and everything makes sense,

"NO GOOD DEED GOES UNPUNISHED."

Where did that originate from and what is the context of it?

I think it came from the biography of the compassionate doctor!

Well, I find that people switch doctors for such a wide variety of reasons, it's hard to get very excited when they come in to request their records.

Their insurance might have changed, the other guy might be on the path of their regular commute, or their personality may mesh better with that of another physician. I have seen many occasions where patients do not want "good medicine" (as I define it). They want a doctor who will do what they ask, without question.

Every once in a while, a patient will switch because they think you're a bad doctor, and I will admit that can be hard to take.

When I left a group to go into private practice 5 years ago, I felt a special gratitude for every patient that followed me into my new practice. It was very flattering when a patient who had seen one of my partners for many years decided that they liked me well enough to switch.

I still remember the anguish I felt when one of my "loyal patients" decided to go somewhere else!

She was an OB patient with recurrent, severe hyperemesis gravidarum who switched to an older, more experienced doctor after I had admitted her five times for the same condition. I think she and her husband felt that I wasn't doing everything that could be done for her. So, they moved to an older physician in the town.

Of course you can guess what happened. She had another recurrence, he admitted her, treated her less aggressively than I had done, and her symptoms resolved, never to return! Of course, her symptoms would have resolved anyway, eventually, but how do you convince the patient of that?

You have to just let it go, and learn to live with that gnawing awareness that there is a young couple in the town of Clarksville, Arkansas that thinks that you're a crummy doctor, and their new doctor is Aesculapius incarnate, when he was really just lucky.

After you come to grips with that fact, the next fact you have to swallow is that lots of your "loyal patients" have probably switched to you under similarly lucky circumstances, and maybe you're not such hot stuff, after all!

Never mind the fact that we sometimes do actually just blow it (lose our temper, miss a diagnosis, etc.).

I think this regular dose of humiliation is actually helpful to the soul, if we respond with humility. It reminds us to keep our head down, treat our patients with kindness, do our job to the best of our ability, and to try not to judge our colleagues too harshly.

Bert,
A few years ago we were privileged to have then AMA President Tom Reardon as a house guest.
I was with him most of the two days he was here and I was impressed with the number of national calls he received from Time magazine, Sixty Minutes etc. and with his ability to deal with the issues wisely.
Tom is a primary care physician and he left me with two pearls that I recall from our many discussions:
1) Always sit down when you go into a patient room. He said that he and his partner spend the same amount of time with their patients, but Tom sits down with every visit and his partner stands (often with his hand on the door knob). His partner consistently received written complaints about always being in a hurry.
2) He said that people say that you cannot put a price on physician/patient loyalty. Yes you can, he said, it is seventeen dollars. That is the amount that the average person will pay per month to retain their private physician versus switching to the less expensive doctor. I expect that this is the category you are in. Here in Springfield, we have two major health care systems and approximately 20% of the patients end up switching providers annually due to their company insurance changing. An easy way to find out would be to simply have your office manager do exit interviews by phone for a few dozen patients. I would not advise doing it yourself; you are too emotionally attached and they are less likely to be honest with you.
Best,
Jim

Initially I felt hurt when people transferred, but I got over it fast. While I have people who have followed me for years (from practice to practice to this office), I have others who leave for a variety of reasons: they owe money and don’t want to pay, I don’t give them what they want (narcotics), they move, they die (as expected of course), or I refer them away. There are some who just leave and I never really know why.

But you know…people change their minds and they do have the right to see who they want. I know some leave and go locally…but you know what, I have more coming in than leaving. Even after 19 months in my own practice, I’m still seeing 2-3 new people per day.

Thanks Jim and Barbara and Brian, et al. Of course, this thread is for everyone. It probably happens to all of us, but I am, as Roy stated, rather sensitive and they have not found a cure.

I must say it's the ones where I never know that get me the most, especially when right or wrong I or the office feel we went out of our way. We had a patient a few months ago that drove the entire office crazy. Couldn't wait until he transferred. And, he did. And we were glad. But, we still all went, why the hell did he leave.

This town is particularly bad for "Doctor Shoppers." It's just the way it is set up. For the most part, we won't take a patient or family back that leaves, but they don't generally come back.