Front Desk on the Front Line
Helping Your Staff Deal with Difficult Patients

By Karen Childress
Karen Childress is a writer for Physicians Practice

You may not know it’s happening, but while you’re busily engaged in the exam room with a patient, there is a drama unfolding in the front office. Your receptionist is smoothing the ruffled feathers of a patient who is taking his anger out on her. Every day, receptionists and other front-desk staff demonstrate that it takes a talented person to effectively work at the front desk in a busy medical office. The best and most experienced can sometimes get rattled, and it’s easy to see why. They are the front line of the office and often must deal with difficult patients.

Extreme examples of difficult patients are those who threaten staff, make inappropriate comments, show up intoxicated or upset your other patients. In most cases, however, receptionists contend with patients who are just garden-variety ornery: the stressed-out executive who got up on the wrong side of the bed, the young mother who was up all night with a sick child or the octogenarian who’s sick and tired of feeling sick and tired.

In thinking about how to respond to challenging patients, keep in mind that few patients visiting a medical office are operating at 100 percent. When people are sick or in pain, small irritations, which might not otherwise faze them, are enough to trigger rude behavior.

Easing frustrations

Kevin Sullivan of Sullivan/Luallin, Inc., a health care consulting firm in San Diego, notes some simple steps that front-office staff can take to avoid becoming the target of a patient’s frustration:
• Acknowledge patients quickly with eye contact and a smile
• Let patients know if delays are expected
• Avoid using complex medical language
• Provide complete and accurate information
• Offer direction about what will be happening to the patient next
• End the encounter with a pleasant comment, such as “nice to see you.”

“If you have four phone lines ringing and six people standing at your desk … the tendency is to retreat to process,” said Sullivan. “Staff will say, ‘I don’t have time to do this smiley stuff because I’m busy getting folks in and out.’” But for the best possible service to patients, it’s critical to keep the “smiley stuff” visible and genuine, no matter how busy the office gets.

One of the most common patient complaints is about waiting time. Obviously, practices should do all they can to maintain an efficient schedule. If the doctor is more than 15 minutes behind schedule, a nurse should make a brief announcement so waiting patients know what to expect. Give them the option to run an errand, go have a cup of coffee or reschedule their visit for another day. It’s not a good idea to leave patients sitting, waiting and wondering what’s happening.

When patients have a complaint, hear them out. An upset patient will more easily calm down if he believes someone is listening to him. In fact, this is a good opportunity to consider how the patient’s ideas could prove useful in improving service in the practice.

Annette Sloan, assistant administrator/COO (chief operating officer) for Specialty Clinics of Georgia in Gainesville, recommends getting an upset patient out of the reception area whenever feasible. “We don’t talk to angry patients in the waiting room or at the front desk,” said Sloan. “I take them to a room we have allotted [for private discussions], or the front-office supervisor will.”

Train staff properly

Giving employees the authority to solve problems is fundamental to providing superior service. An annoyed patient’s feelings can escalate to full-blown anger when the patient has a problem for which no one has a solution. According to Sullivan, staff should be able to say things like “I’ll check into this and call you this afternoon with a resolution” or “I’ll have this fixed by the time you leave.”

“For this,” said Sullivan, “you need authority.”

Staff members need to feel competent and confident to handle challenging situations, and this is where good training comes into play. “We do customer service [training] with every employee as often as possible,” said Sloan. Her practice uses audio/video conferences as one way to keep service concepts fresh in the minds of staff. Sloan expects her team to understand that “we are providing a product — even though it’s health care — and that patients deserve respect.”

Other training options may include a short course in mediation skills, role-playing to show how to address an upset patient in a nondefensive way and instruction about what to do in a genuinely volatile situation.

Setting boundaries

Every practice may have a few patients who are beyond boorish — they are downright abusive. At some point, it’s key to consider whether it’s worth it to continue seeing a patient who has such a negative impact on the office. It may be helpful to have a conversation with a disruptive patient to explain how his or her conduct is hurtful to staff. Otherwise, a formal discharge letter may be in order.

Sullivan suggests that physicians periodically ask front-desk staff how they are doing and how they are managing the stress of the position. This type of conversation lets your staff know that you are interested in their well-being, that you appreciate the skill and grace required for the job and that they are not going it alone on the front line.

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