Unpleasant office staff? It’s one reason for suits — Many claims involve rudeness
When a patient called a pediatrician’s office to ask for a same-day appointment because her child was not well, she received a curt response from the receptionist.
“The mother was known to call often and bring her 18-month-old child for even a minor cold,” explains Molly Farrell, vice president of operations for MGIS Underwriting Managers in Salt Lake City, UT. “The receptionist, knowing the office was busy that day, told her there was no way she could be seen and made an appointment for two days later.”
The receptionist didn’t fully listen to the mother’s complaints, however, and did not inform the nurse or doctor of the call. Within a few hours, the child got worse, and the mother drove her to a nearby hospital.
“Unfortunately, by that time the child had full-blown meningitis and as a result, suffered brain damage,” says Farrell. “Eventually, much of the claim against the physician was dropped, but he still had to pay thousands in defense fees, and his practice suffered because of the negative publicity.”
Rudeness is more than just a customer service issue. It can be the factor that pushes a dissatisfied patient into contacting a lawyer. “Many more claims involve rudeness than we want to accept,” says Farrell.
If a patient has a great relationship with the doctor and the staff, even if there is a bad outcome, chances are there will not be a suit, Farrell says. “However, if the patient has a good relationship with the physician and is unhappy with front office staff, and there is a bad outcome, there is still a higher risk of a lawsuit,” she says.
Even good, caring doctors might not be able to overcome their office staffs’ poor behavior. “It’s as though two negatives and one positive still equal a negative,” Farrell says.
Wrong impression
If front office staff respond curtly to a patient’s request to see a physician, this response can give the patient the impression that they don’t need an appointment. “When that impression is given, rightly or wrongly, and a negative outcome happens, there is the real potential for a malpractice issue,” says Farrell.
During one lawsuit, a plaintiff testified that the receptionist told him he didn’t need an appointment, and the employee acknowledged this response during her deposition. “She said the patient came in all the time, and she figured this was just like all the other times,” Farrell says. “The defense attorney started asking things like, ‘And your medical training was conducted where?’ I felt sorry for the woman by the time they were done with her.”
Farrell recommends that practices have a place in the electronic medical record to document when a patient calls in to ask a medical question and the front office staff responds without first checking with the nurse or physician, or if the patient requests to speak with the physician or nurse about a condition or symptom and that message is not passed on.
Physicians need to understand that they are represented by their front office staff for better or for worse, she says. “The physician who is very involved with how the practice runs tends to get better outcomes and has a lower risk of being sued,” Farrell says. “The doctor is responsible for his office staff. Under vicarious liability, it falls back to him or her,” she says.
Most physicians are aware of their responsibilities to monitor the actions of staff, says Farrell. “The challenge is many physicians never consider the fact that their staff, who may have worked at the office for many years, would ever behave in a manner that could cause legal action,” she says.
Members of the front office staff don’t always recognize the potential for an emergency. If a patient reports headaches, an ophthalmologist’s receptionist might not realize that this symptom could be the beginning of a retinal detachment.
“They may just want the person off the phone as quickly as possible,” says Farrell. “A good practice will have the doctor call the patient back to determine whether they need an appointment sooner.” (See related story, below, on identifying problems with front office staff.)
Learn how staff members really treat patients Is a receptionist or nurse unfailingly polite to physicians, but rude and condescending to the patients who call or present for care? If so, the physician probably has no idea. “Staff are generally deferential to the physician. Your first task is to find out if there is a problem,” says Molly Farrell, vice president of operations for MGIS Underwriting Managers in Salt Lake City, UT. Farrell says to take these steps: • Survey patients with a comment card to place in a box at the front desk, or conduct a short, private email survey. Farrell suggests asking these three questions: — Does the office greet you in a pleasant and friendly manner? — Does the office work to accommodate your scheduling needs? — Does staff follow up with you as promised? Open-ended questions will elicit more qualitative responses, Farrell adds, such as “What was the one thing my staff did you did not like?” and “What one thing did my staff do that you really liked?” • If there is a problem, take it to the next level and invest in a professional survey. “I’m a big fan of secret shoppers. There are firms that provide this service, but you could also ask friends or family to act in that role,” she says. Farrell says to instruct individuals to forcefully request an immediate appointment to how difficult or easy it was and how the staff responded, and watch for these comments that should raise red flags: — “There’s no way to see you today. We are too busy.” — “Call us back in a few days if you still feel the same way.” “It is not always specific comments. It could also be the overall tone or atmosphere created by the office staff,” says Farrell. Patients who feel their illness is not being treated seriously, or who are made to feel uncomfortable by staff, are less likely to bring to medical issues to the office’s attention, she explains. • Over time, aggregate the data and post it on your website. Include the statement: “Your input matters to us. Here are three areas you want us to improve. Here is what we did.” Source/Resource • Molly Farrell, Vice President, Operations, MGIS Underwriting Managers, Salt Lake City, UT. Phone: (801) 990-2400 Ext. 272. Fax: (801) 990-2401. Email: [email protected]. • A web-based tool to measure patient satisfaction is available from the American Medical Association (AMA) and Press Ganey Associates that provides patients with an outlet for feedback on their office experiences in an electronic survey. The price is $100 setup per MD, plus $55 a month for AMA members. Non-AMA members pay $100 setup per MD plus $85 a month. For information, go to www.ama-assn.org/go/patientexperience. Click on “RealTime: A Patient Satisfaction Solution.” |
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