How to deal with difficult patients

How to deal with difficult patients

This was a very difficult week. First, one of my Obstetric patient wanted me to give her all her medical records. Then,  she wrote on my facebook page how disappointed she was with my management. These were her words:

“We chose Dr Selva to be our doctor for the birth of our first child as he was highly recommended. I do not doubt he is an amazing surgeon. However, my experience with him, was, I would describe as minimal. Minimal in the sense that in the first five months of my pregnancy appointments with him, I felt, he did not have the time for me. Appointments were VERY rushed, leaving me to have do further research on my own. It got to a point where I unfortunately had to find another doctor at another hospital to get the information and time (care) that I needed. When I did, there was a lot of information that I did not know, or, was not originally outlined to me by Dr Selva. On a positive note, his personal nurse is so lovely!”

I was obviously upset and apologised to her. Robin Sharma said “ The real cause of failure is success”.  I will have to always remember this when dealing with patients.

The second incident was another patient who consulted me for uterine fibroids. I spent a great deal of time, explaining to the couple,  the different modalities of treatment, which included laparoscopic hysterectomy, laparoscopic myomectomy and HIFU (high intensity focused ultrasound). She had an MRI and a simulation was done to see whether she was suitable for HIFU. The numerous technical and inquisitive questions asked by her made me realise that it would be very difficult to treat this lady. Ultimately, she decided on a laparoscopic myomectomy. I performed the surgery despite my worries. Fortunately, she did well although the recovery phase was tumultuous. After many days of worrying, it was a relief to finally settle her problem.

The third incident was a patient who saw me at 1.30pm on a Saturday. Another doctor referred her to me for HIFU treatment. She did not want me to examine her and wanted me to decide whether she was suitable for HIFU, with an ultrasound scan done by the referring doctor. I had to persuade her to undergo another ultrasound scan, done by me, to decide what were the best options for her. Both she and her mother were bombarding me with questions, many of which I could not answer. These questions gave me a headache. I asked her to see my nurse to get proper counselling on HIFU. This is what I usually do  to educate patients on this new technology. My nurse also had a difficult time with her. She was not happy and placed an unflattering review on my google page. I was upset but it is still my fault. I apologised to her and explained to her about my usual practice in giving information about HIFU. I am unsure whether if ever she comes back to see me, I will be able to treat her.

When a patient consults a doctor, the doctor will need to listen to her medical problems, do investigations and make a diagnosis so that she can be treated. This process is expected to take place in about 30 minutes. That is the amount of time most doctors allocate to their patients since we have other patients waiting for their turn to be seen. Patients, however, expect to have a satisfactory explanation of their illness including treatment options within that period of time. As one becomes more and more busy, giving  extra time can become difficult because of the pressure given by other patients waiting for their turn. This is where the quote by Robin Sharma kicks in “ Success breeds failure”.

So, how do we define a difficult patient? A difficult patient can be one of the following:

  1. Patients who do not want to end the consultation despite a lot of time spent with them.
  2. Patients who ask questions that are impossible to answer like “ why fibroids occur”
  3. Patients who have preconceived ideas of their disease and will not listen to your explanation but keep telling you what another doctor told them about their disease.
  4. Patients who do not tell the truth about their condition and only disclose that they have been seen and investigated by another doctor, after you have examined them and given them your diagnosis. These patients want to  test you.
  5. Patient sho has a doctor as a relative overseas.
  6. Patients who ask statistics on how many cases you have done? Have you been sued?

So what can you do?

These are some of the strategies that I have used,  over the years, to keep patients happy and save me some time, which can be spent to see other patients

  1. Create teaching videos. This is a strategy I developed many years ago. I have created numerous videos on different diseases and conditions so that I can ask patients to watch, in order to understand their disease. A favourite one is “Adenomyosis”. A disease that is very difficult to understand. I have this video in all 3 languages. While  patients  watch this video, I can save time and  see other patients. After they have completed watching the video,  I will talk to them again about  treatment options.
  2. Having counselling nurses. A lot of time is needed, explaining how to do IVF. I have taught my nurses on all aspects of IVF and when a patient is thinking of IVF I will ask them to get counselling from these nurses first,  so that they understand all expects of IVF before they return to me for a final discussion as to whether they are ready to undergo IVF
  3. Place them in a different room and give them some relevant material to read. While they are reading, you can quickly see other patients and then, get back to them to answer their questions.
  4. Encourage second opinion

After 27 years of private practice, I am still, at times battling with difficult patients. Social media has been around for the last 10 years and is becoming a more and more popular means for patients to look for doctors. Even though it is a boon for doctors to let potential patients know of the services they provide, it is can be a double edged sword. One poor review is probably worth 100 good reviews and people remember the poor review more than the good ones. Doctors are only human.  We have emotions and are sometimes  under stress. Patients do not see us that way. When they consult you, they expect a calm and confident doctor who answers all their questions. Even though it is sometimes very difficult, you need to be at the top of your game all the time to please all your patients.




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Dr. Selva

Dr. Selva

Dr S. Selva (Sevellaraja Supermaniam) is a Consultant Obstetrician and Gynaecologist and a subspecialist in Reproductive Medicine at a private hospital in Melaka, Malaysia. He heads the O&G unit and the IVF Centre at the hospital.

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