Home Forums Discussions General Discussion Rude and Offensive Patients

My receptionist just called and said that a patient was upset with their bill. It had gone to collections. The patient was very rude and demeaning to my employee. In the past, I have at times discharged patients who abuse my staff. I am wondering how other doctors/ business owners deal with this as a matter of policy or practice.

Harass my people and you are shown the door, good riddance. On the other hand, we no longer use a collection service. We never really recovered much, and the bad karma wasn't worth it.

We have had success with collections, but more success with requiring a credit card/debit card left on file with a written agreement that we can charge it for balance dues. No matter what you do, you have to make the choice of

1) Losing some patients who don't want to pay you.
2) Letting some patients get away with not paying you.

Patients who feel they can abuse or lecture you or anyone on your staff concerning your policies should be dismissed.

After awhile, you have a self-selected panel of patients that respect you and your staff, are reasonable, and who pay you properly for your services. If they decide they don't like your services as provided, they will calmly explain that and go elsewhere, rather than cause a disruption with the intent of forcing you to do whatever they decide you should do (and how they decide it should be done).

Also, requiring the credit/debit card on file makes your accounts receivable just drop through the basement!

Disrespecting my staff is the same as disrespecting me and most of you know, that is a no no. I tell my staff to kill the patient with kindness then come get me and let me have the joy of disemboweling them!

@ wayne


I'd love to keep credit cards on file and charge them for balances. How do you keep the numbers secure? I worry about a major liability there.

We have a really very tolerant staff, and if they come tell me they are abused we readily discharge patients. It is one of the many joys of being in private practice. The big clinics, especially the hospital-owned ones, feel they have to see all comers.

I don't tolerate anyone abusing my staff. Many times patients are angry about stuff that has nothing to do with them but they seem to like to take it out on the front desk. It's not our fault that your copay is $30, not our fault that you signed in and waited only to find out that we aren't your PCP.

I tell them to go elsewhere

We use Updox. They work with a company called Braintree that specializes in this. So you only have the last four digits of their credit card available to you. Braintree is PCI compliant. We only charge these types of charges through Updox since charges through them have an additional transaction fee.

We also have the patient sign a written agreement for the specific credit card. We redact all but the last 4 digits of the card or better yet tell them to only put on the last 4 digits. This is scanned into the system so we have proof of the agreement.

As the other posts, we fire the patient for the behavior listed including repetitive cancellations. We send them a discharge letter so it formally becomes part of their record. Some go nuclear on social media as we have close to 5,000 fans on our site worldwide. At first I was concerned, but then realized that it tells others that we will not tolerate it. So the ones that want a lap dog will go elsewhere. It does seem that in the last 4 yrs we have seen a marked increase in bad behavior. I wonder if it has to do with the age demographics of the patient changing and we are seeing the wave of entitled & selfish thought process hitting our clinic.

The increase is also partially due to the poor economy and pressure this puts people under. Many employers are especially cruel to their employees when in comes to physician appointments (excuse notes, or just sometime 'no you cant take off") and there is the attitude of saving what leave time they have for vacation. So they try to make this YOUR problem and get upset if you tell them "no". There also seems to be an attitude specifically directed towards private physician offices of being nasty and causing a scene if you cater to their demands--even if it is obvious to them that you should not do so. To some extent I agree this is associated with the age demographics of the patients, just that its not the only thing.

One of the docs from Florida a while back had an irate patient, which got me thinking how to handle unpredictable situations, so we ended up having a monthly nurses meeting with our local police department reps--2 police officers who gave some great ideas on how to deal with dicey situations in the office.

However, one great skill the police officers discussed, and I had never heard of was the concept of verbal judo, redirecting behavior with words, and a book written by George Thompson Ph.D called Verbal Judo was suggested.

We had a followup nurse meeting and the nurse who oversees the meetings read the book and discussed with our nurses and staff, ways to talk disruptive patients down. and was very well received.

I have not read the book yet but on my to do list.

We keep bear spray both in the reception and nurse areas.

The Alaska bears seem to enjoy their meat peppered. The also enjoy the "dinner bells" that people wear when hiking.

Thanks Jimmie for the tip. I will check it out and like the visual.

MJK,

You are welcome .

I discharge the patients immediately. Sometimes staff will tell me that the patients were swearing at or getting annoyed that they have had to fill out our check in system (phreesia...which i wish would do something where pts can check in at home or i can set up a computer for them to type in the answers...but alas still nothing)...and if they were annoyed at or rude to the staff, when i go in to see them, before i see them, i make it very clear that that type of behavior isn't tolerated in my practice and that they will respect the staff..if they continue to bitch about the check in forms, i let them know that other practices have 5 pages to fill out by hand if they would prefer that i am sure there are other docs in the area giving care with an all paper system now, i do always tell the girls if we have older patients to help them as not all older people like new technology. or we offer the paper system and the girls type in info for them.

In short, we don't tolerate rude behavior to my staff or me. we all know a lot of times that pts will be rude to staff and nice to us...so i make it clear to the patients that we don't tolerate behavior like that to anyone.

if i lose a patient, good riddens in my book...in the end those are the f*&% up patients who would sue you anyway for bullsh$t.

Ketan

Some people are just horrid, rude, and intimidating to a young female receptionist, but act very differently with the doctor. It probably isn't worth a recording system, but I'd love to hear what they say. I've told my staff if someone is being rude, to feel free to just transfer them to me.

Had a CEO of a billing company call me and my number automatically forwarded to our crew as I was out of coverage driving between two practices (rural Utah).

Said CEO got increasing belligerent when she was told I wasn't available, and started to trash-talk me. Unbeknownst to her, she happened to get Lori (my Lovely Bride), and that didn't go as planned.

As soon as I hit the hotel that night I Black-Listed said CEO (ALL of her numbers) in our phone system. If you can't behave in a civil fashion on the phone - we don't need to talk.

I just had another patient who called wanting a refill of some Norco. Has not been in for 3 months, and I require being seen at least 4 times a year for chronic pain patients, usually more often than that. I asked my receptionist to set up an appointment for him, and he was very rude and went 'on and on' with her about how he should not have to come in and listen to someone barely older than him 'lecture' him about safety of opioids. He wants a direct call back by the physician.
Question: Would you even call him back? (He has already been told he needs an appointment for a refill.) Just send him letter explaining the policy? Normally I would just call but it sounds like this may result in drawn our argument.

Boondoc,

No--I wouldn't call him--it only encourages such bad behavior. No appointment--no rx. In fact, behavior such as his would be a red flag to me that this may not a good person to be on chronic narcotics.

Nevertheless, these questions are tough. Dealing with narcotics is tough. That's why most of the pain specialists in our area say, "You'll have to see your family doctor about prescriptions."

John

In the state of Indiana, we have new regulations for prescribing scheduled drugs and the monitoring thereof. Some are that you should see them every 4 months, take a detailed H&P, have the patient complete an objective pain assessment tool, sign a treatment plan, receive education concerning the potential harmful effects of narcotics and perform a urine drug screen. And, if they are on the "Holy Trinity" of opiate + Soma + Benzodiazepine you may as well go ahead and tell them they will be SOL on getting refills. I have already lost several patients who became livid when I followed these recommendations. I told them to drive to Kentucky or Illinois then to get their narcotics...good riddance. So, if your patient is complaining about your 4 month rule, tell him to come to Indiana! Now if the ER and Pain Management docs around here would not undermine all the hard work I put into getting people off or doses down by giving them narcotics for a carbuncle life would be good!

Send the letter. Explain the policy, and assuming you told him the policy previously, mention that. Also explain that if he doesn't think you are old enough and/or knowledgable enough to provide this advice, he should seek another doctor. Finally,he needs to personally apologize to your staff or he should consider the letter his 30 day dismissal notice.

oooh Leslie,Indiana is even better. Have a law that says they have to come in every 3 or 4 months. 4 in this case.

One arm of the gov't is fighting the other. CMS has put pressure on ER's to address the "vital sign" of pain and they have to make sure every patient leaves the ER happy with their opioids and signing a favorable survey. On the other hand, the DEA is coming after doctors for prescribing the opioids: it's ridiculous!

I don't refill meds, I don't redo PT scripts, I don't go over MRI and CT results without appointments. If patients don't like it, they can call around, other sports doc and orthos do exactly the same thing.

The reason i won't go over MRI and CT results on the phone is simple, they don't listen to half of what we talk about and then i get 10 calls about the same MRI..my time is valuable, i love answering pts questions but am not going over the same results and the options over and over again on the phone.

How can you not refill meds, no patients on long term meds? Or do you mean, on the phone... Do they come in for all med refills?