Podcast: Play in new window | Download

Subscribe: RSS

In this episode, we cover:

  • Why patients experience the entire practice—not just the physician
  • Five phrases that can escalate patient conflicts, and what staff can say instead
  • How physicians can intervene in an argument and coach employees afterward
  • When staff should handle a concern, hand it off, or follow safety procedures
  • How role-playing and improving office systems can strengthen patient trust

 

Key Takeaway Quote:

“The goal is not patient versus practice. The goal is patient and practice versus the problem.”

 

Connect with Barbara Hales: 

 

TRANSCRIPT:

 

Why Staff Communication Shapes Patient Trust

 

Dr. Barbara Hales  00:04 

Your patient is angry. You know exactly what to say. You’re lowering your voice. You’re listening. You’re acknowledging the frustration, and it’s working. Then someone from your staff says, “Well, that’s not what happened. Oh no! Now the patient is angry. Your employee is angry, and you’re standing between them, thinking, “Could everybody please stop talking? Hello, everyone, and welcome back to Marketing Tips for Doctors. I’m Dr. Barbara Hales. Grab your coffee because today we’re talking about something that can undo even the best physician-patient communication. What happens when your staff escalates the situation? This is episode four of our trust series. In our last episode, we talked about the angry patient and how to keep a difficult conversation from turning into a confrontation. But here’s the problem: you can be wonderful at de-escalation. You can know all the right phrases. You can have the patience of a saint, but if someone on your team is argumentative, defensive, or dismissive, the patient may never get far enough to experience your wonderful communication skills, and that brings us to one of the most important things I want you to remember today: your patient doesn’t experience your doctor. Your patient experiences your practice, including everyone who answers your phone, schedules appointments, discusses bills, handles prescriptions, and greets patients at the front desk. When a prescription becomes an argument, consider this example. Linda calls the office because her prescription hasn’t been refilled. She’s frustrated. She says, “I’ve called twice already, and nobody has gotten back to me. The receptionist looks at the computer and says, “Well, I don’t see any record of those calls. Linda says, “I know I called. I left messages, and the receptionist responds, “That’s not true. You did not call us twice. Now what happened? We started with a missing prescription. That’s a problem we might have been able to solve, but now we have a completely different problem. Who’s telling the truth? Nobody wants to lose that argument. Linda becomes louder. The receptionist becomes more defensive, and suddenly the physician is being asked to step in. Here’s what I want you to notice: the receptionist may genuinely believe no calls came in. Maybe the calls weren’t documented. Maybe Linda called a different number. Maybe she remembers calling but never actually reached the office. We don’t know, but we don’t have to settle that argument before we address the problem. Imagine if the receptionist had said, “I’m not seeing those calls documented here. Let me look into it further and see what we can do about your prescription.” Same computer, same missing documentation, completely different Conversation. Instead of fighting about who’s right, they’re working together to solve the problem, and I want your entire staff to understand that distinction. The goal is not patient versus practice. The goal is patient and practice versus the problem, not staff. Before we go any further, I want to be fair to your employees, because sometimes patients are difficult. Yes, that’s true. Sometimes they’re demanding, sometimes they’re unreasonable, and sometimes they’re downright rude. Unfortunately, all true. Your receptionist may have been answering phones nonstop for three hours. Your medical. Assistant may be covering for someone who called out sick. Your billing employee may have explained the same insurance issue 15 times that morning, and now somebody is accusing them of incompetence. Of course, they’re frustrated. They’re human, but here’s the distinction: feeling defensive is understandable. Responding defensively is not always helpful, and that’s where training comes in. We can’t expect staff members to instinctively know how to de-escalate every difficult situation, especially if nobody has ever taught them what to say. Five phrases make things worse. I would love to retire from medical offices with these five phrases. The first is “calm down. We talked about this in the last episode. Has anyone ever become calmer because somebody ordered them to calm down? I haven’t seen it. The second is that’s not what happened. Even if it’s true, it’s likely to turn the conversation into an argument. Try, let me see what I can find out. The third is that’s our policy. Patients often hear that as stop asking questions. Instead, try. Let me explain why we handle it this way and see what options we have. The fourth is There’s nothing I can do. Try. Here’s what I can do. And the fifth is that’s not my job. 

Phrases to Retire and Better Responses

Dr. Barbara Hales  07:01 

Oh, that one is particularly irritating. The patient doesn’t necessarily know who handles what in your office, and frankly, they shouldn’t have to memorize your organizational chart. Try billing; they handle that, but I’ll connect you with the right person. See the difference. You’re not promising something you can’t deliver. You’re simply refusing to make the patient feel abandoned. Let’s look at another situation: the $75 copay. Frank arrives for an appointment. The front desk tells him he owes a $75 copay. Frank says, “I already paid that. The employee looks at the screen. “No, you didn’t. It’s showing as unpaid. Frank says, “I have the receipt. The employee says, “Well, our system says you owe it, and now we’re off to the races. Frank thinks the practice is trying to charge him twice. The employee thinks Frank is being difficult, and the physician may not even know any of this is happening. What could the employee say instead? I can see why you’re concerned about being charged twice. Our system isn’t showing the payment, but let’s investigate before we collect anything again. Now the employee hasn’t admitted the practice made a mistake, and they haven’t accused Frank of being wrong. They’re simply moving the conversation toward a solution. That’s the skill. Does the doctor even know? I want to tell you about a conversation I actually had. This wasn’t one of my patients. I was speaking with a patient who was complaining about how rude the staff was in another physician’s office, and I said something to the effect of, “Maybe the doctor doesn’t know they’re behaving that way. The patient looked at me as though that was ridiculous. She said, “Of course the doctor knows. If the doctor didn’t condone it, it wouldn’t happen. That stayed with me because I remember thinking, “Does the doctor really know? The doctor may be two exam rooms away seeing patients. They’re not necessarily hearing how the telephone is being answered. They’re not standing at the front desk; when somebody questions a bill, they’re not listening. When a frustrated patient asks for the third time why a prescription hasn’t been called in, the doctor may genuinely have no idea. But here’s the part that matters. The patient assumes you do, and if the behavior continues, the patient doesn’t necessarily think, “What an unpleasant receptionist.” They may think this is the kind of practice this doctor allows. Fair, maybe not, but perception doesn’t wait for all the evidence, and that brings us to an uncomfortable leadership question: How do you know what’s happening in your own practice when you’re not in the room? What if you could hear it yourself? Think about that for a moment. The way your staff speaks to patients when you’re standing there may differ from how they speak to patients when you’re two exam rooms away. That doesn’t mean you assume your staff is doing something wrong. It means good leadership does not rely on assumptions from either side. One possible tool for training and quality improvement is reviewing appropriately obtained recordings of patient interactions. I mean telephone conversations, and we are legally permitted and have properly obtained consent for certain in-person conversations. Imagine being able to review a difficult interaction with your office manager and ask, “How could we have handled this conversation differently? Not who we can blame, not who deserves to be reprimanded, but what we can learn. Sometimes hearing your own words is more powerful than having somebody tell you what you said. An employee might not realize how abrupt their tone sounded. They might not realize they interrupted the patient repeatedly, or that a phrase they thought was perfectly reasonable sounded dismissive. But I want to be clear: recording patient interactions raises important legal and privacy issues. Recording and consent laws vary by state and depend on the circumstances and jurisdiction. Consent from everyone involved may be required, and in a medical practice, the recording may capture protected health information. So, don’t put a hidden recorder at your front desk or in an exam room and assume it’s okay. Before implementing any recording program, telephone or in person, have your healthcare attorney, compliance or privacy professional, establish what is permitted, how appropriate notice and consent will be obtained, where recordings can occur, how they’re secured, who can access them, and how long they’re retained. 

Handling Conflict and Coaching Staff 

Dr. Barbara Hales  13:19 

The purpose should be education and quality improvement, not secretly catching employees doing something wrong. And remember, you don’t need recordings to start improving communication. You can begin with role-playing, patient feedback, direct observation, and staff training. The key is to know what’s happening in your practice, not just assume. Now, let’s say the situation is already escalating. A patient and employee are arguing. You walk in. What should you do? First, don’t humiliate your employee publicly. You don’t want to say, “Why would you say something so stupid? That doesn’t help anybody, and you don’t want to throw your employee under the bus just to make the patient happy. Instead, take control of the conversation calmly. You might say, “I can see we’re having trouble resolving this. Let’s figure out what happened and what we can do next. If necessary, move the conversation to a private space. Let the patient explain the concern, then determine the next step. Later, when the patient is gone, speak privately with the employee, and don’t start with, “You can’t talk to patients.” Start by telling me what happened from your perspective. Listen, then ask What were you trying to accomplish when you said that. You may discover the employee was trying to defend the practice, correct misinformation, or prevent an inappropriate request. Their intention may have been perfectly reasonable, but the language didn’t achieve what they meant. Now you can coach. Next time, instead of saying that’s not true, try Let me see what I can find out. That’s actionable, that’s teachable, and that’s much more useful than simply telling someone to be nicer. What about when a scheduling error turns into a battle? Here’s another example: James arrives for what he believes is a 2 p.m. appointment. The medical assistant says, “Your appointment was at three.” James insists no. They told me two. The employee responds. Well, the schedule says three. James says Then your office made a mistake. The employee says we didn’t make a mistake, and now they’re arguing over a scheduling discrepancy. An office manager steps in and says, “It sounds like there was a misunderstanding about the appointment time. Let’s see what we can do to get you taken care of. Notice what she didn’t do: she didn’t decide who was right. She didn’t accuse anyone of lying. She did not promise an appointment she couldn’t provide. She redirected the conversation towards a solution, and sometimes that’s all it takes. Teach your staff when to get help. One of the most useful things you can do is establish a clear escalation plan, because not every difficult patient interaction needs the physician, but staff should know when they’re getting in over their heads. I like to think of it in three levels. Level one, frustration. The patient is unhappy. Maybe they’re upset about waiting, a bill, or a scheduling issue, but they’re communicating. They’re willing to listen, and the employee can usually handle the situation by listening, acknowledging, and working towards a solution. Level two: escalating. The patient’s voice is rising. The employee is becoming defensive. They are repeating the same arguments. Nobody is getting anywhere. That’s when staff should get help. Maybe from an office manager, maybe from a supervisor, maybe from the physician if appropriate. And I want your employees to understand something: a handoff is a skill, not a failure. Knowing when to bring in help is part of good judgment. Level three: unsafe or abusive. Now we’re talking about threats, intimidation, harassment, discriminatory abuse, or physical aggression. That’s different. Your employees are not required to tolerate abuse. Your practice needs clear safety procedures for these situations. Empathy doesn’t mean letting someone threaten your staff. You can be compassionate and still maintain boundaries. In fact, you should. What about the hot-headed employee? Now let’s address the elephant in the room. What if an employee seems to argue with everybody? You coach them. You give them scripts. You explain the importance of patient communication, and the behavior continues. At some point, this becomes a performance issue, because one employee can undermine the reputation you’ve spent years building. But before you decide the problem is simply a bad attitude, look at the environment. Is the employee overwhelmed? Is the practice chronically understaffed? Are patients routinely waiting too long? Are billing policies confusing? Does your team have any authority to solve? 

Escalation Plans, Team Training, and Systemic Fixes 

Dr. Barbara Hales  19:59 

Are they constantly told to enforce policies they didn’t create and can’t explain? Because if five employees are suddenly short-tempered, maybe you don’t have five employee problems. Maybe you have one systems problem, and fixing it may do more for patient trust than any lecture on customer service. Let’s look at the practice before the problem happens. Here’s something I would encourage you to do at your next staff meeting. Spend 10 minutes role-playing. I know nobody loves role-playing, but it’s better to practice a difficult conversation when everyone is calm than to invent the right words when someone is yelling at you. Give your staff a scenario. A patient says, “I’ve called three times, and nobody ever calls me back. Ask, what would you say? Let someone answer, then discuss it. Try another. Your office is trying to charge me twice, or I’ve been waiting an hour. This is ridiculous. Practice the response, not just the words, but the tone, pace, body language, and ability to listen without interrupting, because de-escalation is a skill, and skills improve with practice. Here are five phrases everyone should know. If I could put five phrases on a card at every workstation, they would be these. Tell me what happened. I can understand why you’re frustrated. Let me see what I can find out. Here’s what I can do, and I think we need some help resolving this. Let me get the appropriate person. Simple, yes, but sometimes simple is exactly what people need when emotions are running high, and I put another card right beside it. Five phrases to retire. Calm down. That’s not what happened. That’s our policy. There’s nothing I can do. That’s not my job. Just replacing those phrases can make an enormous difference in how patients experience your practice. Support your staff too. I want to emphasize something before we finish. Your staff needs to know you support them, not just when they’re right, but when they’re trying to do the right thing in a difficult situation. Tell them, “I expect you to treat patients respectfully, and I expect patients to treat you respectfully too. That’s an important message. You can hold employees accountable without making them feel disposable, and you can protect patients without assuming every complaint means your staff did something wrong. Good leadership requires both. This is marketing too. Now you may be wondering, Barbara, what does all of this have to do with marketing? Everything. Think about how much time and money physicians spend trying to attract new patients: websites, social media, online advertising, search engine optimization, reviews, referrals, all designed to bring someone into the practice, and then that person calls and has a terrible experience, or arrives for an appointment and gets into an argument at the front desk, or has a billing question and is told that’s not my job. Your marketing worked. Your experience failed, and the patient may never come back. Worse, they may tell other people. Your receptionist may never think of herself as part of your marketing team, but she is. So are your medical assistant, your biller, your scheduler, and everyone else who interacts with your patients, because your reputation isn’t built only on what you say about your practice. It’s built by what patients experience when they deal with your practice. Your one tweak this week. Here’s what I’d like you to do at your next staff meeting: choose one phrase your team uses that may be making difficult conversations worse. Just one. Maybe it’s that’s our policy. Replace it with, ” Let me explain why we handle it this way and see what options we have. Practice it. Encourage your team to use it, and pay attention to what happens. You don’t have to change everything overnight; start with one phrase, one conversation, one small improvement, because those small changes can protect something enormously valuable. Patient trust. Before we go, I’ve created a free patient trust guide called “When Trust Is on the Lion. It’s designed for you and your entire team. You’ll find information on how to access it in the description, and if you found today’s episode helpful, share it with your office manager or staff. Just don’t send it with the subject line “This is about you. 

One Small Change to Build Trust Before Trouble 

Dr. Barbara Hales  26:36 

That probably won’t help with de-escalation. Also, subscribe to Marketing Tips for Doctors, because in our next episode we’re going to turn this entire conversation around. We’ve spent four episodes talking about what happens after trust is threatened, but what if we stopped waiting until something went wrong? What if your website, your staff, your communication, your office systems, and you were deliberately building trust with patients from the very first interaction? Could you create enough trust before a problem happens that your relationship is strong enough to survive one when it does? That’s what we’re going to talk about next: building trust before trouble. I’m your host, Dr. Barbara Hales. Thank you for joining me on Marketing Tips for Doctors, and remember, you’re one tweak away from greatness. Until next time.