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Недовольный пациент



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What Makes Patients Unhappy: A Podiatric Survey

Many medical malpractice lawsuits are related to the patient‘s dissatisfaction with an event which is unrelated to the outcome of the care the patient received. A survey was given to 23 podiatric physicians in the state of Utah to determine what makes their patients unhappy. Each physician listed the five events that that upset their patients the most. The doctors completing the survey came from different areas of the state, including rural and metropolitan areas. Some doctors‘ practices are clinic-based, while other practiced in a HMO environment, and many physicians practiced from a private office. Table 1 shows a graph of the number of years in practice among these 23 doctors ranging from 1 to 25 years.

TABLE 1


Responses from the survey fell into one of six different categories including scheduling appointments / waiting times, communication skills, excessive charges / incorrect billing, insurance hassles, poor treatment / poor surgical results, and other problems. Each category will be discussed later in this article. Table 2 shows a list of all the responses completed in the survey and percentages of inspanidual categories. 


Scheduling problems accounted for 18% of the responses given in our survey. Patients realize there is a waiting period when they visit their physician, but are usually displeased when they have to wait more then 30 minutes for a scheduled appointment. They consider their time valuable and if the physician cannot see them in a timely manner, then an appointment should not have been scheduled. Patients also get frustrated when it takes weeks to get in to see their doctor. They feel if their foot problems if severe enough to warrant an office visit, then they should be seem as soon as possible. Podiatrists should refer the patient to another physician if they cannot schedule the patient in a timely manner. Office staffs and podiatric physicians can keep their patients happy by being on time and by accommodating patients‘ schedules. 



Litigation often arises from a miscommunication, an uncaring attitude of an unfriendly doctor or staff member. Communication skills accounted for 23% of the responses given in our survey. Doctors not spending enough time with the patient, unavailability of the doctor, and poor phone manners of the staff and / or doctors are a few of the responses classified in the communication category, Other responses include doctors not taking patients‘ concerns seriously, doctors bad-mouthing other physicians, not being completely honest about expected results, and unfavorable doctor rapport. Physicians can avoid potential lawsuits by developing a caring attitude, and a good doctor-patient relationship by being available to meet the patients needs and creating a friendly atmosphere. Written instructions should be given to every patient pre-and post-operatively to avoid any miscommunication from the physician. Above all the physician should be conservative ( longer disability times an higher problem rates should be cited no best case scenarios ) when telling patients the expected length of disability or the likelihood of complications or failure of treatments. 



Incorrect billing, excessive charges or surprise billing comprised 19% of the responses in our survey. Patients become dissatisfied when they think they have been overcharged for medical care. Often, patients are unaware of medical expenses until months later when they receive an insurance statement and have forgotten the immediate benefit of the service performed. Patients realize that medical care is expensive and will pay for reasonable fees. However, some patients become upset and will consider litigation if they feel their physician has taken advantage of them by charging excessive fees. Billing problems can be avoided by good communication between doctor and office staff, by charging reasonable fees, and by helping patients understand what the fees include. Don‘t promise patients their insurance company will take care of everything. 



Insurance hassles (including non-covered services like orthotics, difficulty obtaining a referral, and insurance exclusions) accounted for 12% of the survey responses. Insurance companies are making it difficult for doctors to be reimbursed for services rendered and patients to receive necessary medical care. Patients do not understand why they pay expensive insurance rates and still have non-covered services like orthotics therapy. Patients become unhappy when insurance companies limit their medical treatment options. Unfortunately insurance struggles area going to be more unpleasant in the future for both the physician and the patient. Physicians should help patients by working with their insurance company without compromising necessary medical treatment. 



The category of poor treatment included 22% of the responses given in our survey. Treatment issues ranged from poor surgical results, unexpected length of postop disability, and poor medical treatment. Other responses consisted of high cost of prescription drugs, orthotics that are uncomfortable, and multiple visits for the same condition without any improvement. Physicians sometimes have complications postoperatively. When the physician deals with the complication in an effective manner, it can help the patient to recovery and avoid possible ligation. An informed consent form should include a list of all possible complications for the particular surgical procedure. Excellent preoperative surgical planning can help avoid poor surgical choices and unfavorable surgical results. Be realistic and honest about expected results and postop disability. Make an extra effort to assure that the patient understands the risks and postop care involved. Above all avoid "head in the sand syndrome." Remember if it looks like a complication, it probably is. Treat it immediately and aggressively because if you wait, it will probably get worse. A trusting doctor-patient relationship, good communication skills, along with excellent surgical technique can help avoid a poor surgical outcome. 



Other responses comprised about 6% of the results from our survey. Patents were concerned with parking problems, being mugged, outdated reading material, and with government involvement in health care. Other concerns included the patient seeing a resident instead of the attending physician, a cluttered or an unorganized office. Physicians can help their patients with these concerns by providing adequate parking, creating a safe environment, and having up-to-date magazines. 



The results of the survey show that podiatric physicians can avoid possible litigation problems by providing excellent podiatric care, treating patients with a caring attitude, charging reasonable fees, developing a favorable doctor-patient relationship, having good communications skills, to insure proper surgical planning, and acquiring excellent surgical techniques. 


TABLE 2

A. Scheduling 18%
 - Waiting too long for scheduled appointments.
 - Too long of a wait to get a scheduled appointment
15
4
B. Communication 23%
 - Unfriendly staff or doctor
 - Poor communication
 - Doctor not spending enough time with patient
 - Doctor not taking patient‘ concerns serious
 - Unavailability of doctor/not on call
 - Poor phone manners by staff 
 - Doctors who bad-mouth other doctors
 - Not being completely honest about expected results 
 - Patient complains about other podiatrists
6
8
2
2
2
1
1
1
1
C

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