OCT 2012

EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.

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Page 149 of 168

Ethical strategies for taming tempers waiting room, seething. It's 45 min- utes past his appointment time, and his post-op refraction after cataract surgery doesn't meet his expecta- tions. Mr. Jones is frustrated, angry, and targets an unsuspecting recep- tionist to unload on—in front of a waiting room of people. Sound familiar? If it doesn't yet, it will. P Ophthalmologists across all special- ties are bound to run into a cantan- kerous, volatile patient eventually, regardless of physician skill or staff professionalism. "It happens a couple times a year," said Vonda Syler, C.O.E., McDonald Eye Associates, Fayetteville, Ark. "I can think of one several years ago who got really irate and was taking it out on the staff. He was quite unbearable in the office. It did get to the point where I had to talk to him about his behavior; as in most circumstances, he had other issues in his life that were affecting his behavior and calling [this] to his attention changed his attitude." Physician protocol Dealing with an angry patient pres- ents a number of challenges to staff and physicians. Although situations vary, there are best practices an office can invoke regardless of the circumstances. The number one priority for all parties is controlling emotions. "It's important the physician never communicates any hostility toward the patient, no matter how much the clinician dislikes the patient or wishes that the patient be treated by someone else," said John Banja, Ph.D., professor and medical ethicist, Emory University, Atlanta. icture this: It's a busy day at the clinic and you've fallen behind schedule. Mr. Jones paces around the Gary Foster, M.D., a Colorado- based cataract and refractive sur- geon, agreed. "The natural reaction when someone expresses anger toward you … is to respond with anger," he said. "But that escalates the tension and decreases the chance that any successful resolution will be accomplished." For instance, if a patient is frustrated with his treatment, both Drs. Foster and Banja strongly recommended physicians approach the patient with kindness and compassion. "The first step is to make sure you give the patient a chance to express clearly what he's frustrated about," said Dr. Foster. "The second step is for the doctor to say he is sorry that the patient is frustrated about this issue, which is very differ- ent from saying you're sorry and it's your fault." When having a potentially con- tentious conversation with a patient, Dr. Foster sits next to the patient, rather than across from him, so they're on the same team. He also makes sure to show the patient on a chart exactly where they are in treat- ment and outline on paper how they can partner to move forward. The emphasis is on working together to solve the problem and meet the original goal. "It's hard to get and stay angry at someone who tirelessly supports you and obviously wants to help you," said Dr. Banja. Staff strategies Staff, though, have to handle angry patients a bit differently than physicians as the issues are dissimi- lar. Staff tends to receive the brunt of patients' bad attitude, especially when patients don't understand their bill or feel their time is being disrespected. Regretfully, these instances are likely to unfold in the middle of a busy waiting room with a captive audience. In those situa- tions, the most important step is to immediately move the angry patient into an isolated exam room or office so others aren't unnecessarily alarmed. The next step is to have either the attending physician or office administrator "inform the patient that his or her upsetting comments to other patients in the waiting room aren't appropriate and cannot be tolerated," said Dr. Banja. An administrator's job doesn't end with disciplining the problem patient, however. The administrator has to contend with the patients who witnessed the confrontation who may have questions about the situation. It's here that the impor- tance of staff training comes into play, as HIPAA laws put a gag order on how much staff can reveal. "Sometimes you can say a word or two to diffuse things and make everyone smile a bit, but you're limited with what you can do with that," said Dr. Foster. Although you continued on page 18 Dealing with an angry patient presents a number of challenges to staff and physicians. Although situations vary, there are best practices an office can invoke regardless of the circumstances October 2012 • Ophthalmology Business 17

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