My patient is threatening me. What can I do?

Dr. Nice has many happy patients and takes pride in his interaction with them. He knows that he is human and has made mistakes. However, he tries never to look back and ask what was I thinking in dealing with anyone in particular. He also knows that if you practice long enough, you will have some patient you wish you had not treated. 

A year ago, he performed a series of IPL procedures on a male patient for facial redness. With each subsequent treatment, the patient became increasingly unhappy and belligerent. Despite this, neither he nor his staff saw any red flags regarding this patient. Ultimately, the patient demanded his money back. Even such a demand did not phase Dr. Nice. What did cause concern was a statement from the patient that if such a refund was not provided, Dr. Nice, his family, and staff would “regret this.”

Such an interaction does not lead to a discussion about recognizing red flags. It is also reasonable for a patient to communicate constructively with their dermatologist. Patients expect  to see improvement and, of course, reasonable people can disagree as to the degree of improvement. Suffice to say, if a patient is legitimately injured due to negligence, they have remedies. They can file a lawsuit. They can complain to the State Board of Medical Examiners.  But what about patients who barrage the practice with nasty emails, phone calls, and potentially threaten the office? 

Dr. Nice should initially try to de-escalate the conflict. He certainly will lose nothing by listening to his unhappy patient. This might actually solve the problem. Many doctors have succeeded at this stage merely by being a sounding board. Anybody can have a bad day or a bad week. If a patient needs hand holding during a rough patch, listening might just do the trick. If, as a dermatologist, you are given the opportunity to listen, don’t interrupt after eight seconds. Communicate, communicate, communicate. This can solve many a problem. 

Unfortunately, sometimes patients will not be placated; some patients may have a history of psychiatric problems and might benefit from seeing a psychologist or psychiatrist. However, not all patients are willing to listen to such advice. Alternatively, some patients might benefit from getting a second opinion to reassure them that they are on track for their recovery. Some physicians will even pay to have these patients seen by a respected colleague. This could be money well spent.   

Unfortunately, patient complaints are not always a money issue. In our cash-pay elective cosmetic era, some dermatologists  occasionally do give patients some or all of their money back in exchange for a complete release. Or they will perform more treatments where they waive their professional fee in an attempt to extend their relationship with the patient. This just becomes the cost of doing business. The guiding principle in each of these cases must be approached and handled on an individual basis. 

The problem for Dr. Nice is that he may have a patient that is bent on disrupting the practice and has escalated his attacks. Now what? 

Obviously Dr. Nice cannot continue the doctor-patient relationship. It will likely need to be terminated in the proper way. You cannot abandon a patient. But there are formal ways to move the relationship towards closure. A “divorce” might be appropriate here.  

If a dermatologist reasonably believes the patient is a threat to the safety of other patients, staff, or him/herself, this must be reported  to the police. Dr. Nice might even consider temporarily hiring a guard.  If the problem persists, a restraining cease and desist order may be required. Lastly if  his patient engages in assault or battery, he can have the patient arrested and charged with a criminal offense. 

Fortunately, such events are not common. But they cannot be ignored. The average physician sees thousands of patients at the same time. Always better to be careful than sorry.