Over the course of my career as a Healthcare Risk Manager Consultant I have been asked to review many requests for records by various agencies and individuals. Frequently, these requests are attributed to a patient who states they are unhappy with the results of the procedure and want their money back. Often times the events that precede the request for records provide a strong indication of what is to come.
In discussing many of these patients with the surgeon I would always ask if in hindsight there was anything you could point to that may have provided a clue this could be a patient that could be trouble. The overwhelming response is that the patient may have had higher expectations for the results of the procedure than was attainable. In every instance the surgeon clearly documented what the patient wanted. The surgical approach that would best get that result was discussed. And the expected results were well documented.
When dealing with plastic surgery many times the patient has a specific image in their mind of what they want to look like. Often times this body image is not effectively communicated by the patient making it impossible for the surgeon to fully understand. What usually transpires is the patient voicing their concerns at the post-op visits. As is customary the patient is assured they will be pleased with the results once they have fully healed. This will usually calm the patient for a few days but quickly they become impatient and again communicate their concerns to the surgeon. Since most offices have an office manager that deals with patient issues the patient becomes even more agitated because they want to look like they were told they were going to look like and they want to talk to the surgeon directly.
The chain of events from here usually calls for multiple phone calls and emails. The patient may state they sought out the opinion of another doctor who of course told them they should have had a better result. They will then ask for their money back and when the money is not refunded they will soon start a campaign to discredit the surgeon and facility. There will be posts stating their dissatisfaction in social media, business rating agencies such as YELP and even on your own website. When the patient gets no satisfaction from their rants they then decide to either seek an attorney to file suit or there have been cases where the surgeon is reported to a state agency for malpractice. This is where you now either get an attorney letter requesting the complete medical record or a subpoena for records from the state agency. If the patient paid by credit card they will seek to have the charges reversed. In a subsequent article I will discuss what PHI can be disclosed in disputing a claim by the patient.
This is where the surgeon usually states it wasn't worth it. The nuisance, the time in responding to the patient and the requests made this an unprofitable case in the end. So how can you identify these patients? First of all use your intuition. You have performed hundreds, if not thousands of cases and your intuition is a good guide. Just don't let your intuition be swayed by dollars and cents. Listen, we are all business people and our goal is to make money to be able to exchange that for the goods and services we desire. But sometimes the best business deal is the deal you don't do. So don't let your intuition be swayed by your desire to "book the case". But you should also include a screening process in your patient consultation to ensure that you understand what the patient is communicating and they understand what you are communicating back. The most effective approach is to have the patient bring in pictures of somebody they are trying to look like and to also have them write it out. This approach will clearly communicate what should be reasonably expected from the procedure. It will also give you insight into what the patient expectations are and whether or not these are reasonable. If they are not remember, don't be afraid to say no.
In closing, I would like to state that none of the request for records resulted in any action against the surgeon or their licenses and none were taken to trial. Some surgeons did decide to refund some of the money and had the patient execute full releases. Just one more reason to properly document in the patient's medical record.