- Joined
- Nov 18, 2002
- Messages
- 5,220
- Reaction score
- 2,441
As a private practice emergency doc in a small democratic group where what we collect has a direct bearing on my monthly paycheck, I'm a reasonably big proponent of customer/patient satisfaction type stuff. Not that I'm huge into it, but most docs seem to think they could walk out into the waiting room every couple of nights, and shoot half the patients without having a drop-off in their salaries.
But there are some patient satisfaction issues I don't worry about. Let me list a few.
1) The drug-seeker
I feel like I'm pretty good with people with narcotic issues. I spend a lot of time with them. I go over their CSD report in detail with them. I recommend treatment. I offer non-narcotic alternatives. I suggest other therapies and always offer to do an appropriate diagnostic work-up and often even offer to treat them with a narcotic if the work-up demonstrates something that I think merits one. But if they become upset I don't try to make them happy. I just calmly repeat what I will and won't do. I don't care if they hammer me on a patient satisfaction survey. If they're really bad, I just add "Drug seeking behavior" to the list of diagnoses and that ensures they won't get a survey. If they complain to the ED or to administration, our medical director or administrator looks up the chart, sees they're a drug seeker (because I always document what the CSD says and while we see patients with 3600 pills in the last year all the time, an administrator or lawyer has no idea that's going on) and supports me. If I happen to miss something and they go to the lawyer, the lawyer gets their records, sees this guy is a druggie and decides he doesn't want to get involved either.
2) The personality disorder patient
Maybe they're borderline or narcissistic or whatever. While I do my best to treat them as well as I can, I know from the beginning they won't be satisfied. But I also know that any attorney, administrator, or future doc that talks to them down the line is also going to quickly realize they're nutty. After 5 minutes, they're all going to hate the person. You want to be involved in a lawsuit for 3-5 years with a client you hate? Didn't think so. Lawyers are people too.
3) The patient I psych-hospitalize against their will
I've had a complaint from an SI patient I forced to be hospitalized who had a rotten time in the psych ward. I don't care. One mistake there and I get to spend 3-5 years dicking around with lawyers because I sent a suicidal patient home. If you are no longer suicidal, you better be convincing, honest, and trustworthy and have some friends or family members who are the same. If I get even a hint that you're not, it's off to the psych ward for you. And that chart will be buffed so well no one will ever question the decision. Plus, psych patients don't get patient surveys either.
4) The mean idiot
Sometimes I have a patient that is so dumb that they can't put it together enough to form a complaint or go through a malpractice suit. If they are also purposely unpleasant to me and my staff (and not actually ill), I stop worrying about them so much. Turkey sandwich? Heck no. Don't feed the bears.
5) The drunk who doesn't want to be tied down
I really don't worry a bit about tying people down and knocking them out against their will. It is actually really safe to tie someone down in an ER using 5 people, giving them a B52, and putting them on a monitor. Far safer than letting them walk out the door in that condition. Most of the time, they're much kinder after they sober up. Sometimes they're not. But you know what? Who is going to go to an administrator or a lawyer who is going to read their chart and see they were so drunk that they had to be tied down and knocked out and expect the administrator or lawyer to care? If the administrator or lawyer gives me crap about that, who do you think I'm going to call to take care of it the next time it happens?
6) The guy leaving AMA
Lots of people leave AMA. Most of the time they didn't need to be there anyway. And when they do, I have and document an appropriate conversation about the risks. Then I hand them the form and go back to my business. I don't lose any sleep about it. I don't beg them to stay. I make sure they're competent, I make sure they understand the risks, and I make sure I document those facts. Some of my favorite experiences happen when they get home to take care of their dog (or whatever dumb reason they wanted to go home) and their wife sees they left AMA with a diagnosis of cholecystitis and she marches them back to get admitted.
7) The guy who tells me he isn't going to pay me
These are usually dental pain patients. They have no dental insurance. They have no medical insurance. For some reason they think it's better to go to the ED and get a $1500 bill and not have the problem fixed than see a dentist, get a $150 bill, and have the problem definitively fixed. They tell me upfront they can't pay the dentist and don't have insurance. If they can't pay the dentist $150 you think they're going to pay me? Of course not. Do I care if this guy chooses my ED over the one down the street next time? Nope. Am I nice? Sure. Do I tell him what the best thing for him to do is (get a medical screen out from me so he doesn't get a bill and go see a dentist?) Sure. Do I care if he isn't happy that he got Pen VK, ibuprofen, 6 lortabs, and a dental block instead of 30 percocets? Not a bit.
Attention patients- If you want top-notch care, you might want to treat those delivering it as well as you can. It is amazing what an emergency doc and nurse will do for you even if they don't care about you. But they'll go to the ends of the Earth if they do.
But there are some patient satisfaction issues I don't worry about. Let me list a few.
1) The drug-seeker
I feel like I'm pretty good with people with narcotic issues. I spend a lot of time with them. I go over their CSD report in detail with them. I recommend treatment. I offer non-narcotic alternatives. I suggest other therapies and always offer to do an appropriate diagnostic work-up and often even offer to treat them with a narcotic if the work-up demonstrates something that I think merits one. But if they become upset I don't try to make them happy. I just calmly repeat what I will and won't do. I don't care if they hammer me on a patient satisfaction survey. If they're really bad, I just add "Drug seeking behavior" to the list of diagnoses and that ensures they won't get a survey. If they complain to the ED or to administration, our medical director or administrator looks up the chart, sees they're a drug seeker (because I always document what the CSD says and while we see patients with 3600 pills in the last year all the time, an administrator or lawyer has no idea that's going on) and supports me. If I happen to miss something and they go to the lawyer, the lawyer gets their records, sees this guy is a druggie and decides he doesn't want to get involved either.
2) The personality disorder patient
Maybe they're borderline or narcissistic or whatever. While I do my best to treat them as well as I can, I know from the beginning they won't be satisfied. But I also know that any attorney, administrator, or future doc that talks to them down the line is also going to quickly realize they're nutty. After 5 minutes, they're all going to hate the person. You want to be involved in a lawsuit for 3-5 years with a client you hate? Didn't think so. Lawyers are people too.
3) The patient I psych-hospitalize against their will
I've had a complaint from an SI patient I forced to be hospitalized who had a rotten time in the psych ward. I don't care. One mistake there and I get to spend 3-5 years dicking around with lawyers because I sent a suicidal patient home. If you are no longer suicidal, you better be convincing, honest, and trustworthy and have some friends or family members who are the same. If I get even a hint that you're not, it's off to the psych ward for you. And that chart will be buffed so well no one will ever question the decision. Plus, psych patients don't get patient surveys either.
4) The mean idiot
Sometimes I have a patient that is so dumb that they can't put it together enough to form a complaint or go through a malpractice suit. If they are also purposely unpleasant to me and my staff (and not actually ill), I stop worrying about them so much. Turkey sandwich? Heck no. Don't feed the bears.
5) The drunk who doesn't want to be tied down
I really don't worry a bit about tying people down and knocking them out against their will. It is actually really safe to tie someone down in an ER using 5 people, giving them a B52, and putting them on a monitor. Far safer than letting them walk out the door in that condition. Most of the time, they're much kinder after they sober up. Sometimes they're not. But you know what? Who is going to go to an administrator or a lawyer who is going to read their chart and see they were so drunk that they had to be tied down and knocked out and expect the administrator or lawyer to care? If the administrator or lawyer gives me crap about that, who do you think I'm going to call to take care of it the next time it happens?
6) The guy leaving AMA
Lots of people leave AMA. Most of the time they didn't need to be there anyway. And when they do, I have and document an appropriate conversation about the risks. Then I hand them the form and go back to my business. I don't lose any sleep about it. I don't beg them to stay. I make sure they're competent, I make sure they understand the risks, and I make sure I document those facts. Some of my favorite experiences happen when they get home to take care of their dog (or whatever dumb reason they wanted to go home) and their wife sees they left AMA with a diagnosis of cholecystitis and she marches them back to get admitted.
7) The guy who tells me he isn't going to pay me
These are usually dental pain patients. They have no dental insurance. They have no medical insurance. For some reason they think it's better to go to the ED and get a $1500 bill and not have the problem fixed than see a dentist, get a $150 bill, and have the problem definitively fixed. They tell me upfront they can't pay the dentist and don't have insurance. If they can't pay the dentist $150 you think they're going to pay me? Of course not. Do I care if this guy chooses my ED over the one down the street next time? Nope. Am I nice? Sure. Do I tell him what the best thing for him to do is (get a medical screen out from me so he doesn't get a bill and go see a dentist?) Sure. Do I care if he isn't happy that he got Pen VK, ibuprofen, 6 lortabs, and a dental block instead of 30 percocets? Not a bit.
Attention patients- If you want top-notch care, you might want to treat those delivering it as well as you can. It is amazing what an emergency doc and nurse will do for you even if they don't care about you. But they'll go to the ends of the Earth if they do.
