The bad economy has resulted in many people losing their jobs, their homes, and/or their insurance coverage. People are overly stressed and panicking; resorting to actions that they would probably not have done under normal circumstances. One such response that I have seen increase in my practice is disrespectful behavior and abuse by patients toward me, my staff and the physicians.

The staff is trained on appropriate “customer” service techniques and they know that if they cannot diffuse the situations they need to ask for assistance from a supervisor. There have been extreme situations that require me, as the Administrator, to intercede. I can remain calm and in control in just about all situations. Confrontation, though not sport, is not something that I fear. I have had several experiences, however, that have given me pause.

One such moment was a result of a patient who demanded that we change his name in our computer system from his legal name to the name he preferred. His insurance card and driver’s license both had his legal name. Our system only allows one version of the patient’s name. Because it is mainly for billing, we have to use the name that appears on the patient’s insurance card or the claim would get denied. Several people attempted to explain this fact in a calm manner; however, the patient was very adamant. The front office supervisor called me to discuss the issue with the patient and, again, I proceeded to explain the reasoning behind using his legal name. I suggested that he notify his health plan and have them change his name on his insurance card and we would be able to accommodate his request. Apparently, he did not find that to be a reasonable suggestion and became increasingly irate and lunged over the counter at me, while yelling. As I was backing up, I asked him not to lunge toward me. He continued to yell, adding that he wasn’t lunging, all the while he is halfway over the counter hands flailing in the air.

On another occasion, a male patient wanted the medical assistant to code his labwork with a diagnosis code that would be covered by his insurance; however, it was not an accurate code for the services provided and not something approved by the physician.  She tried to explain this to him and he verbally assaulted her in the hallway on the way to the lab.  I was notified of this episode and confronted him about what had transpired.  He was very aggressive.  He proceeded to tell me that it was none of my business, even though I introduced myself as the Administrator of the practice.  I explained that what he did was not acceptable and his language was offensive and that is why it is my business.  I asked him to explain what had happened so I could attempt to respond to his concern and attempt to rectify the problem.  He proceeded to explain the request for the code change and that the medical assistant would not comply.  Unfortunately, I could not grant his request and attempted to explain the reasoning behind it.  His anger level rose another level and he yelled that I was supporting my employee and I was not providing “customer” service.  Vulgar name calling began spewing out of his mouth.  As I was trying to get him to calm down, I saw his right arm cock, fist closed, and knew that I was about to receive a blow.  Luckily, I was very aware of my surroundings and had my peripheral vision in tune…I backed away, picked up the telephone and called the police.  The patient left the office screaming.

These are just two of the more extreme examples of what I have personally experienced.  I fear for the safety of my staff, the physicians and myself.  Recently, I installed security locks on the doors between the reception area and the back office.  The ones that require someone from the back to “buzz” the door to unlock it.  About a year ago, I installed panic buttons at check-in and check-out.  When depressed, an alarm sounds and an immediate call notifies the police department.  I have only had to use the panic button once, but that was for an employee who was not happy that she was terminated and would not leave the premises.

I remain concerned and cautious regarding the safety in our office.  The threats are ever increasing, some of the known causes of these threats include:

  • Insurance companies creating an antagonistic reaction in patients toward their physicians.
  • Entitlement mentality that health care is a right.
  • Poor economy and resulting financial problems experienced by patient.
  • Belief that physicians are “rich” and the patient needs the money more than the physician.
  • Narcissistic society, “I want what I want when I want it and I am not accepting no for an answer!”.
  • Our society has entrenched the “squeaky wheel” mentality and many people start out with that approach.

I don’t have the answers.  I am very interested in hearing other people’s stories, recommendations, and thoughts to improve safety.  Please comment!