Attorney Alex Thiersch sees what can happen when problem patients become cosmetic practice nightmares.
Problem patients, he says, have been known to retaliate for their dissatisfaction by calling the U.S. Drug Enforcement Administration (DEA), claiming illegal narcotics were being distributed at practices. They’ve called the FDA to claim the use of counterfeit Botox (Allergan). They’ve called the police, who have shown up at practices unannounced.
All this, just because a practice agreed to treat an unreasonable or “problem” patient.
“We don’t have any direct data or evidence on this, but anecdotally it appears this industry attracts its share of problematic patients,” according to Thiersch, a partner at ByrdAdatto in Chicago and director of the American Med Spa Association.
It could be the nature of specialties aimed at enhancing patients’ looks.
“…that will lead to patients that want more than they need, or who have issues with their self-image, so I think [cosmetic medicine] naturally lends itself to that,” he says.
Among the traits of problem patients: they never seem to be satisfied; they always want more; and they have issues with price, according to Thiersch.
“This person generally is more likely to complain, do a bad review or file a lawsuit,” he says.
How to Avoid Problem Patients
One way to avoid problem patients is not to attract them to the practice in the first place. For example, offering significant discounts via Groupon, Living Social or an event might lure problem patients. In fact, Thiersch tells The Aesthetic Channel that all five of the lawsuits he was handling for medical spas at the time of his interview were with people who purchased Groupons for cosmetic treatments.
“[Shoppers] tend not to be the best patients because they’re not looking for quality in a doctor — they’re looking for price,” he says. “You just need to make sure that no matter what the environment is that you’re sticking to your protocols for how to vet problem patients.”
Thiersch says the best advice for cosmetic surgeons is to vet difficult patients before they treat them, which can be especially challenging for physicians just starting a practice.
“It’s very difficult to deal with problem patients once they get into your practice and you actually treat them, so really the only line of defense that they have is for you not to treat them in the first place,” he says. “We always advise the client that it’s not worth chasing the dollar because a problem patient is going to cost you ten times as much — in energy, attitude, atmosphere of your practice and, potentially, legal fees — as you’re going to make by treating these patients.”
Identifying these people early on is a team effort, which includes staff and doctors.
“Most of the time, doctors are busy and don’t necessarily spend as much time with patients as the staff does. The staff can really spot these things, so you have to listen to them and trust them,” he says.
Red flags include people who have had lots of prior providers and haven’t been happy with any of them.
“There are some good patients who have had a bad outcome and need to be corrected, and that's one thing. But typically patients who are continually complaining about other providers… are indicative of somebody who is not going to be happy with you,” he says.
Another potential clue that someone is going to be more trouble than they’re worth: scheduling is nearly impossible. If they never seem to be available, ask to come in after hours and complain about the time it’ll take them to come in for a consult, it raises the red “diva” flag and could mean more trouble down the road, according to Thiersch.
Chances are that patients who are rude to the desk staff, demanding and are continually questioning pricing and a doctor’s worth will also wreak havoc in the practice.
“A lot of this seems self-evident, but it’s much, much easier for me to say it than for me to actually pick it up in practice because many of these patients are going to be very nice, very personable,” he says. “You really need to learn to take your time and have your staff take their time in the consult, to look deeper than just what’s going on on the outside.”
Just Say No
It’s easier for a physician to end a potential doctor-patient relationship before it actually becomes one.
“During the consultation process, you haven’t really established a true physician-patient relationship, so you don’t necessarily need to abide by state laws regarding discharging a patient,” Thiersch says. “If you’ve actually treated a patient and need to discharge them, there are requirements that states have regarding discharging patients, including whether you have to give them a referral.”
Doctors should send a firm but polite message if they’re going to tell patients they won’t treat them. Thiersch says one approach is for the doctor to say he doesn’t feel qualified or isn’t the best provider to give a person the result he or she is looking for and offer a referral to someone else. Another option is for the doctor to say he doesn’t agree with what the patient wants and doesn’t think it’s in the patient’s best interest.
“The last thing you want to do with patients like this is get into a back and forth with them, because you just can’t win with a patient like that,” he says.
What About Backlash?
Thiersch says doctors worry that turning away potential patients will result in bad reviews.
“My response to that is, with these patients, the chances of getting a bad review are increased no matter what. But you’d rather have a bad review where you can say I didn’t treat this patient, as opposed to saying I treated them and then they complained about my work,” he says.
Regardless of whether a doctor has treated a person, it’s important to protect the person’s privacy, Thiersch says.
Things get stickier when discharging established patients. There are rules about what to do with medical records and more.
“You can’t abandon patients in the middle of treatment, so there are certain obligations that you need to know before you actually discharge a patient. If you don’t want to get an attorney to tell you that, you should be able to find that [information] relatively easily through your state medical board,” he says.