Last week we made an evaluation of all complains that were done by patients at IVF-SPAIN during the second quarter of 2015. According to protocol, complains have to be answered as priorities. But once in a quarter we like to make a little qualitative ex-post evaluation. 6% of patients complain in written or oral form and we register all communications.

dishonest-patient-jpgWhen patients try to obtain advantages
While most complains were related to different aspects of communication, 14% had no real base for dissatisfaction, but reflected how sometimes patients try to obtain a discount or any other kind of advantage. Notice, that 14% of these kinds of situations, mean only 0, 8% of complains. This is an extremely low number. Yet, those kinds of situations produce more emotional impact and work for the clinic’s staff and for the patient’s themselves. These kinds of patients are not consciously cheating, but are truly convinced that they are right and deserve satisfaction.

One example: a British couple sends 12 mails in a week; all of them answered timely and with the required information. Usually couples send 3 to 4 mails per week. Despite this, they wrote a 13th mail protesting against the “unacceptable service level” and demanding all treatment documentation in order to go to another fertility clinic. The answer attended their demand and their next mail insisted on the bad service level and added: “how are you going to compensate us?”

Other patients, this time form Spain, demanded the full reimbursement of their travel costs after having bought their tickets and accommodation without having had any appointment for consultation. They just appeared without informing the clinic of their trip and if happened unluckily on a Saturday evening, when the clinic is closed.

A US patient did not inform properly about the shipping of her husband’s sperm and thus a confusion of shipping providers happened. She threatened with litigation, despite the situation happened because she did not follow the clinic’s protocol that was communicated to her.

Is there bad faith?
In this blog we have written a lot about how patient centeredness and the importance of an excellent patient honest-dentistryexperience is the best for both patients and healthcare providers. Yet, a small percentage of patients try to get advantage from providers, like this article shows.

Of course this is something difficult to prove and we would harm patient’s interest, but also those of our institution, if patients were directly accused of cheating. But sometimes the healthcare provider must set clear limits.

Experience shows that in this kind of situations there is not so much bad will as a tendency to get compensation once the patient feels that in a given situation the clinic has impaired the patient. This tendency reaches from a true sense of justices (“I deserve compensation”) to directly roguery, as in the case of the British patients described before. Normally a single conversation is enough to clear the situation. Only one time we had to ask patients to try with another clinic.

Why do I talk about abuse? Because in the cases I am talking about, although patients have a subjective perception of damage, the perception is not right when looking at objective facts. Only then we can talk about abuse. When there is an error at clinics side, there is no abuse, but a legitimate demand of patients to get compensated by an error. Another question is if a discount is the right way to compensate, since a medical service is not an act of consumption, like a bad meal in a restaurant.

Context matters
In many cases patient’s perception is conditioned by cultural context. For instance, in the example of the British patients seeking compensation, in the Anglo-Saxon world it is very normal to ask for responsibilities. Dutch patients are usually twice as critical with IVF-SPAIN as patients from other nationalities. In the Netherlands assisted reproduction is free and provided by the State. In a Spanish private clinic they pay an amount that is not small for what they obtain free in the Netherlands (with far lower success rates and long waiting lists for donors, must be said) and therefore demand a very high level of service and show a very low tolerance with minor issues such as a delay in the waiting room. And they are really annoyed when there is a charge outside of the treatment’s price (for example for an extra test that is needed). Dutch patients are much more demanding in Spanish private clinics, which offer far higher pregnancy rates and higher quality standards, than in their healthcare system, where they do not feel precisely satisfied (in fact, many Dutch couples seek fertility treatments in Belgium only because doctors are more kind; see article).

pinochio patientHow to act when patients breach limits
When we perceive that a patient tries to abuse the healthcare institution we can follow the points described below. Normally life is not black and white and even if we perceive that patients might try to get advantage, they will often be right at many points. Anyway, when managing these kinds of situations, the point is not who is right, but how to help patients to get to the best situation for them and of course for the institution too.

  1. Do not enter into an e-mail war to refute accusations
  2. Identify objective facts and quantify them if possible: exact data will objectify an emotionally loaded discussion.
  3. The data source should be the electronic medical records or the ERP system.
  4. Present the objective data in an official document and offer the patients the possibility of a talk with the highest possible medical officer. Offer several time and date options for the call.
  5. This conversation should always point to the patient’s clinical situation, offer alternatives, clinical when possible. Try to make them part of the solution.
  6. It is important that the patient’s counterpart is a physician, not the quality manager or a non-clinical officer.
  7. Do not enter into money bargaining.
  8. Leave always a door open to allow patients save their face.
  9. Do not let patients to blackmail the organisation and do not feel intimidated if they threaten to publish their case in social networks and internet
  10. If abuse persists, be clear and show limits. If necessary recommending a different healthcare institution.

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