We live and work in an era where patients expect to get what they want and make their complaints known if they don’t.  In the minds of many of our patients, steroid shots and Rocephin cure the common cold, and antibiotics are the only way to get rid of a sore throat.  Providers find themselves pulled between educating patients on why they don’t need treatment and giving them what they want (within reason) to avoid a complaint.  

One of the responsibilities of my Urgent Care job is dealing with patient complaints. Whether we like it or not, the business of medicine requires us to consider patient satisfaction. So, I deal with phone calls, emails, and negative online reviews. A frequent one I see/hear is, “The doctor didn’t do anything!!”

The Complaint

A similar situation occurs when I work in the ER when patients have already been seen for their complaints.  Once I find this out, I ask the patient where they were seen and what was done for them.  The conversation too often goes something like this. 

Patient – “I was seen at the other ER last night, and they didn’t do anything for me.”

Me – “You were seen at the ER for abdominal pain, and they didn’t do anything?  Did the doctor see you, talk to you, and examine you?”

Patient – “Yes.”

Me – “Did they check your urine or run labs?”

Patient – “Well, yeah, they did.”

Me – “Did they do any imaging?  X-rays, CT, or US?”

Patient – “Yeah, but they said everything was normal, and they didn’t do anything!”

As the saying goes, every story has three sides: the provider’s side, the patient’s side, and the truth.  How should we think about this as providers?  Why does the patient feel this way?  Are they complaining because they didn’t get what they wanted, or was there a deeper problem with the patient interaction?  As providers, why do we feel this way about patient complaints?  Are patients unreasonable in their expectations, or are we not providing what our patients need?  

Patient perspective

instant gratification

1. The patients expect immediate improvement in their symptoms. 

    We live in a world of instant gratification: drive-throughs, fast food, and online deliveries to our door.  Patients want to feel better now; many in the medical and pharmaceutical industries have encouraged this expectation.  Many of our less scrupulous colleagues have trained patients on steroid injections and antibiotics for their viral illnesses. At the same time, IV hydration clinics have taught patients that we are all dehydrated and vitamin B12 deficient. As providers, we must manage these expectations. Educating the patients on their disease process creates both understanding for them and credibility for you.  It may also prevent the patient from feeling that nothing was done when they don’t magically feel better in 2-3 days.  

    2. Patients feel like you aren’t spending enough time listening to them.

      Patient time constraints are another casualty of modern medicine.  As providers, we are continuously expected to see more and more patients in the same amount of time.  Add this to an ever-increasing documentation burden, and we are forced to spend less time with our patients.  A busy Family Practice office may schedule established patients every 15 minutes (or less).  We are expected to average three patients per hour in the UC, or one every 20 minutes, and the ER simply has no limit.  Patients often (rightfully) feel that we do not spend enough time with them.  So, as providers, we must balance our increasing time constraints and giving our patients the time and attention they deserve.

      3. The patients believe prescription medicine is always superior to OTC medication.

        Whether this is from personal experience, drug company marketing, or a reverse placebo effect, patients want prescription medication.  I try to educate my patients on OTC medications to help with their symptoms, whether that is cough suppressants, decongestants, nasal sprays, or NSAIDs.  However, I find that patients prefer prescription medications and feel like I do more when I provide them with a prescription. Many times, “My provider didn’t do anything” may simply mean that they didn’t receive a prescription.  In terms of patient satisfaction, prescription Bromfed works better than OTC Dimetap, even though it has the same ingredients.  Etodolac provides more relief than OTC Ibuprofen.  

        4. The patients expect the same treatment as other physicians have given them.

          “My doctor always does X, and I get better right away.”  We have all heard some variation of that from our patients, and very few phrases trap us in a corner quite the same way. When we hear this, the patient clearly has expectations and will feel like the provider did nothing if those expectations are not met. Our response to this probably varies depending on several factors, including our mood that day, how many times we have heard it that day, and how close to the end of our shift we are. 

          While I try to be a good steward of antibiotics, I’m not naïve enough to think I will make a difference by not giving patients the antibiotics they expect. I try to educate my patients on their illnesses and what might help. But more often than not, I succumb to their request because this is not the patient satisfaction hill I want to die on.  

          5. The patients need diagnostic clarity to manage their expectations appropriately.

            Patients sometimes feel we did nothing for them when they don’t receive a precise diagnosis.  This is the problem I commonly see in the ER.  No one in their right mind honestly believes that nothing was done for them when they had medication, testing, and a CT scan. Still, without clear communication about their diagnosis (or lack thereof), patients often feel let down.  New providers may tell patients with a viral respiratory infection, “Your tests are negative; we will treat your symptoms,” However, the patients may hear that nothing is wrong with them, which clashes with how bad they feel.  

            Provider perspective

            Employer Expectations

            Managing these expectations will likely depend on the type of hospital system or business in which you work.  I worry less about patient satisfaction when dealing with the uninsured frequent fliers at the county hospital than I do working at our for-profit urgent care clinics.  While I try to treat all patients the same, the mandates from my two employers regarding patient satisfaction are different.  

            Our Urgent Cares have direct competition; patients can choose where they receive care.  They will go to our competition if we don’t meet their expectations.  My employer takes all complaints and negative reviews seriously, striving for reputation management by making each patient’s experience positive.  However, there isn’t as much choice in our geographic area when it comes to Emergency Care, although Free Standing ERs have changed this equation somewhat.  It isn’t that they don’t care about patient satisfaction, but with the volume and acuity seen at this particular ER, medical management is simply a higher priority than patient satisfaction.  It’s usually not the person having a STEMI that leaves a negative review online but the person with two days of URI symptoms or two years of abdominal pain.  

            It is, therefore, important to understand what metrics your employer values.  Are they throughput (door-to-provider time, wait time, door-to-door time, patients per hour), financial (RVU per patient, RVU per hour, average chart code), or patient satisfaction (number of complaints, average satisfaction scores)?  Your employer can’t have it all.  It’s like the old real estate axiom: “You can have it fast, cheap, or good.  Pick two.”  

            Looking Through The Patient’s Eyes

            As providers, we face endless administrative red tape, frequently changing documentation requirements, and patients treating the UC and ER like their primary care.  We deal with patients who refuse to take ownership of their health, rarely knowing what medications they take or what medical problems they have.  We battle the monotony that creeps into medicine and the search for the elusive work-life balance.  Add trying to meet unrealistic patient expectations to that list, which can take a toll.

            We instinctively fight back with dark humor and jaded personalities, especially as ER and Urgent Care providers.  Our natural reaction to a complaint is that the patient had unrealistic expectations or that they just didn’t get what they wanted.  However, there is a more constructive way to respond.  When you receive a complaint, why does the patient feel this way?  

            Let’s look at it from their perspective.  Did you explain the expected duration of their symptoms?  Did you make them feel like you spent enough time with them?  Did you give them a prescription medication if they wanted it?  Did you listen to their expectations based on prior medical visits (what their last doctor did, if they mention it)?  Did you discuss their diagnosis (or lack thereof) in terms they can understand?  We should attempt to understand the patient’s perspective and find ways to temper their expectations and mitigate their complaints.  

            patient satisfaction and experience

            Tips and Tricks 

            Here are a few things I do to limit, not eliminate, complaints.

            1. Sit down when I go into the patient’s room.  This gives the illusion that you have all the time in the world for them.  
            2. Regardless of treatment, tell the patients how long they should expect to feel sick.  
            3. Educate them on medication side effects and why (or why not) you feel medicine is necessary.
            4. Give prescriptions for symptomatic relief for nausea, cough, musculoskeletal pain, etc.  
            5. Deliver education and guidance with confidence.  
            6. If you don’t have an exact diagnosis, explain what they don’t have.  “I don’t know why you are having a headache, but I feel confident it isn’t a brain tumor, subarachnoid hemorrhage, meningitis, or sinus infection.”  These are the terrible things, so most likely, it is self-limiting.  
            7. Give them the chance to ask questions and answer them.     

            I can’t say for sure these things make any difference, but I know my flow in the clinic is fast; I do not spend nearly as much time with the patients as some of my coworkers, and I still rarely hear patients complain that I did nothing for them. 

            Conclusion

            The unfortunate reality is that we won’t make every patient happy.  Some patients simply have unrealistic expectations.  We don’t have magic hands and can’t perform miracles for our patients in a 10- 15-minute office visit.  However, not all patient complaints are invalid.  If we follow the steps above and look at the visit from the patient’s perspective, we can limit complaints and poor reviews.    

            Let’s support each other in the ongoing battle against the “my doctor did nothing for me” syndrome.   If you have any good stories, tips, or tricks, please leave them in the comments below.  Subscribe to the blog so you don’t miss any content on BusinessIsTheBestMedicine.com.