Civility at the Medical Office

Over my 8 years as a medical practice manager I have had my share of patients not on their best behavior. I often have to tell patients no, we cannot do that because of 1) office policies, 2) federal policies, or 3) legality. It is at this point that the abusive language begins and I am accused of no customer service, being mean, and other colorful remarks. (The best question was, “Do you work at Wal Mart?" Still trying to figure out that insult.) Customer Service is not to do everything that the patient/customer wants, but to provide the best service/product at the best price with the best staff/employees. I have had many discussions with patients who are not happy with the answer, but I have never had to call 911 to get an abusive patient out of my office. Well, that streaked ended this week.

The Joint Commission released a report June 3, 2010 citing increased violence in the workplace.

After my encounter I found this article, which states that “Nationwide, health care is one of the most dangerous industries to work in, especially if you work in an ER.”

What caused this outburst on this particular day? The patient was 15 minutes late for her appointment and by office policy I informed her we could not see her today and that I would be happy to reschedule. The vast majority of all medical offices have a policy that if you are late for your appointment you are rescheduled. Most people are upset that they missed the appointment, but understand, reschedule and move on. I told her we could not see her and I would be happy to reschedule. She would have none of it. She insisted on being seen. I offered three times to reschedule her appointment. After the third time I asked her to leave. I told her if she did not leave, I would call 911. She said go ahead, and I did.

I have puzzled over the years why normal people become raging idiots in a physician’s office and I believe I have developed a theory. It is because people have been told for several decades and very recently that healthcare is a right. Thus if healthcare is a right, then people are relieved of the obligation of civility. Healthcare is a service, provided to the general population by educated professionals. We are guided by the ethics of our profession, the legality of our profession, federal guidelines, and general good business practices. Yes, medicine is a business and as such my policies are designed for optimal customer service. In this case, the late patient told me that my response was bad customer service and as such she should be seen. However, there are other customers we service in a day; approximately 50 patients are treated on a daily basis. All the other 49 patients made it to their appointments on time, so it would be poor customer service to allow the late patient disrupt their appointments because she was unable to make it to her appointment on time.

I realize that the bad behavior will not stop because I will not be able to accommodate every patient’s desire, needs, and perceived rights. I am able to only do what is ethical, legal, and in the best interests of the business. This is an anathema to the current trend that healthcare is a right, but healthcare is not a right. It is a privilege and as with all privileges patients must be more responsible in regards to their behavior in healthcare settings, or there will be no healthcare because professionals like me will simply leave and go to a less stressful profession, like selling shoes.