Whats Important: The Unhappy Patient

Light, Terry R. MD

Journal of Bone & Joint Surgery - American Volume:
doi: 10.2106/JBJS.16.00887
The Orthopaedic Forum
Author Information

1Loyola Stritch School of Medicine, Maywood, Illinois

E-mail address: tlight@lumc.edu

Article Outline

Like most orthopaedic surgeons, I think I’m a nice guy and a very effective “communicator.” When I tell patients what is wrong with them and what they have to do about it, I am really clear. If they don’t understand, I can speak louder or repeat myself. When someone questions my judgment, I can explain how many certificates I have hanging on the walls of my office. It seemed to me that this attitude served me OK for my first decade in practice. At the end of each clinical session, I was sure that I had helped lots of people with my wisdom. If they were unhappy with my advice, they were free to go elsewhere.

Eventually, because I was doing so well, I was appointed department chair. It sounds like a great job. It turns out that there are some downsides. What I didn’t realize was that anytime a patient had an unhappy experience with one of our 40 faculty members, he/she would write me a letter or complain to one of my bosses.

The first time I got a letter from an unhappy patient, I launched a full-fledged Senate-style investigation. I read all of the patient chart notes, talked to the nurses in clinic, and interviewed the physician whose care or judgment was found lacking. I then called the patient to relate the findings of my investigation. In most cases I was able to effectively defend the actions of our staff and explain to the person with the complaint why what we did was “right.” In truth, most of the people I spoke to were polite, but few seemed happy with or soothed by my investigative efforts.

One day I received a multipage letter from a woman who was unhappy with the care that her husband had received from one of our department physicians. When the paper chart arrived in my office it ran 3 large volumes. It was Friday afternoon; I could spend the next 2 hours reading all of the details or I could head off to our summer home in Michigan.

I compromised. I headed for the parking lot, but I took the letter with me. As I was getting onto the Eisenhower Highway, I dialed the patient’s home number. His wife answered. I explained that I had received her letter but hadn’t had a chance to review the chart. Could she explain what happened? She began talking. I thanked her for sharing her concerns with me. She kept talking. I reached downtown Chicago and turned onto the southbound Dan Ryan Expressway. She explained what she perceived as rude behavior from our front desk and insensitive remarks from one of my partners. I started to try to explain that she misinterpreted our folks’ intent, but I bit my tongue as I turned onto the Skyway and paid my toll. She kept talking as I crossed the state line into Indiana. I listened as she explained her frustration in trying to care for her chronically ill spouse. Medicare didn’t pay for a lot of the items that we had suggested. She had a limited income, and we didn’t understand how hard it was for her.

I began to understand that she didn’t care about any investigation I might launch. She wanted to be heard and understood. Listening was better than any explanation that I could provide. As I approached Michigan City, Indiana, her voice softened and she seemed to run out of energy. She abruptly brought our conversation to an end. She didn’t really thank me, but it seemed like we both felt better. I was a bit lonely as I passed the state line into Michigan.

Since that time, I have stopped my witch hunt investigations. Now when I get a letter I wait until I have a chunk of time, as occurs with a long drive, and I then call the unhappy author and try to listen. I ask open-ended questions and resist the impulse to interrupt or explain. I listen. Unfailingly, after unloading what’s on his/her mind, the tone of the person’s voice softens and the initially unhappy patient or family member spontaneously closes the conversation. I try to learn from these conversations how we have fallen short of the mark. I now know that being a good doctor is not simply about being “right.” It is about understanding the patient’s point of view. I honestly thank anyone with a complaint for helping us find out how we can do better.

In my own practice I work harder to ask open-ended questions and shut up. I try to find ways to connect with each patient as an individual, asking about his/her profession, hobbies, and family and then listening to the answers.

I try hard to avoid the “I’m right and you’re wrong” mindset. When patients have a gripe, I thank them for sharing their unhappiness and vow to do better next time. I realize that they really don’t care much about my explanation but appreciate that I validated their concern with an open ear.

A few months ago, a nice woman sought my advice about numbness and tingling in her hand. I asked her who had referred her to my office. “Oh,” she said, “we spoke a number of years ago after I wrote you a letter about my husband. You listened and seemed like a nice guy. I never forgot you.”

Disclosure: The author indicated that no external funding was received for any aspect of this work. The Disclosure of Potential Conflicts of Interest form is provided with the online version of the article.

Copyright 2016 by The Journal of Bone and Joint Surgery, Incorporated