A new study from the University of Florida found that patients’ rudeness towards their physicians can have a “devastating” impact on medical care. Patient rudeness may play a critical role in medical errors, which by some analyses are now the third leading cause of death in the US. The Florida researchers determined that patient rudeness causes more than 40% variability in hospital physician performance. (By contrast, poor judgment due to lack of sleep led to a 10-20% variance.)

The reason for the huge variance is that despite intentions to ‘shake it off,’ experiencing rudeness disrupts cognition, even when physicians are determined to remain objective. The researchers found that key cognitive activities such as diagnosing, care planning, and communication are all affected — and the effects last the entire day.

The study suggests that patients need to understand the potential for rude behavior to  undermine their care, even when clinicians try their best to be patient and understanding, and even when the rudeness is driven by understandable frustration. But I think the results are also a reminder to practices to try to limit patient frustrations in the first place.

Doctors often bear the brunt of patient rudeness when aggravation and anxiety boil over, even though most of what bothers patients happens before they even see their physician.  Because administrative issues are frequently the source of dissatisfaction, it’s possible for practice staff to prevent or ameliorate many blow-ups. Doing so may help patients have more productive visits with their clinicians, while also helping to protect the practice’s reputation and maintain a pleasant work environment for the entire team.

If you’re concerned about emotional patients disrupting your practice, here are a few ideas to consider:

  • Evaluate, minimize your wait times. A long, unexpected wait in reception is a sure-fire source of patient frustration. When it happens in your practice, is it a rarity or SOP? If running significantly behind is an everyday occurrence your practice, consider a review of your scheduling processes, to come up with a schedule that is attainable. And make sure your front and back office staff are working together to troubleshoot when emergencies or other contingencies cause unexpected delays for some patients.
  • Head-off predictable conflicts. In some practices, patients routinely complain about clinical or administrative policies that can’t be changed. For example, some patients may expect antibiotics to be prescribed for viruses, or school or government forms to be completed on-demand. These conflicts can be avoided in many cases by reminding patients at scheduling time and at check-in, so that they are not surprised by what their physician tells them.
  • Prepare patients for bills. Unexpected costs are another predictable source of patient aggravation. Staff can help by preparing patients for their costs before their visit. For example, preventive visits are almost always free of patient cost-sharing, except when the patient brings up a problem or the physician finds one. Alerting patients to this possibility at the time of scheduling, and again at check-in, helps avoid misunderstandings.
  • Extend a hand. Staff can often spot anger or frustration in patients who are waiting in the reception area or an exam room or on the phone waiting to speak with their doctor. Do they know what to do in those situations? Sometimes, patients’ emotions can be defused by something as simple as asking if everything is okay. Even when the patient’s issue can’t be solved immediately, a kind word or assistance from a staff member or manager may help ensure the patient’s encounter with their physician isn’t disrupted or undermined. Make sure staff has adequate training and encouragement to handle these delicate situations.

 

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