Dealing With Problematic Patients

By Alex Thiersch, AmSpa

The Medical spa and medical esthetic industries are intensely competitive, so it seems counterintuitive that a practice would consider turning away potential business. However, some patients can cause practices great harm - much more than their potential financial benefit could ever counterbalance. It's important for medical spa owners and operators to recognize these troublemakers before they create problems for their business. 

The root of the problem - disgruntled patients - are an unfortunate part of the medical spa and medical esthetic industries. Much of the time, grievances can be resolved with little or no trouble; however, some difficult patients simply cannot be reasoned with. They are committed to misery.

"Because the nature of medical esthetic services is to help people with their outward appearance, you have a subset of people who have have serious mental health issues related to their appearance, and who are fundamentally unhappy and have unrealistic expectations," said Harry Nelson, co-founder and managing partner of Nelson Hardiman.

Spot Trouble/ Set Boundaries

A practice that screens patients carefully can minimize its exposure to problematic patients. 

"The key is to identify potential problem patients early on and figure out how to reroute them away from your practice without offending them," stated Nelson. "If you only listen to people up front, they'll tell you everything you need to know."

Problematic patients: Do not show up for appointments, don't follow instructions for treatment, are disruptive and don't pay.

Medical spas and esthetic practices can head off the issues these patients present by explaining their policies explicitly. Each practice should enlist an attorney to produce a legal document that clearly presents the conditions under which a service will be provided, and patients should sign it prior to any procedures.

Proceed Gently 

The contract will not totally protect the practice from legal action, but depending on the jurisdiction, it can effectively condition service on not posting negative statements online.

"Cosmetic patients are uniquely likely to vent online in ways that can be professionally damaging using various doctor-rating websites or sites such as Yelp," said Nelson. "I've had a number of clients who have had their professional reputations badly damaged by troubled or difficult patients from medical spas." Therefore, cutting ties with problem patients must be handled with the utmost tact and discretion. 

"The key is to try to handle the process as gently as possible, so patients don't leave so agitated that they want to keep their grievance alive," said Nelson. "It's important to convey regret that you're unable to treat the patient and to let the patient know that you wish them the best. It's ideal to recommend alternatives to them, and I think it's better to do it in person and to do it informally. Try to be an active listener and to be firm in your decision, but sincere in saying that you're sorry that it came to this."

Insuring Your Future

Medical esthetic practices and their employees can prepare themselves for the eventuality of problem patients by making sure their insurance policies contain provisions that help protect them from unwarranted legal action. 

"If a compliant is filed against a person and a governing board or body conducts an investigation, many malpractice policies will include a provision referred to as administrative defense or disciplinary proceedings coverage," said David Shaffer, vice president of Professional Medical. "This coverage provides an insured with reimbursement for the costs they incur during an investigation. The amount of coverage varies by insurer, but it typically ranges from $5,000 to $25,000." Some of these policies offer protection from repetitional harm and assistance to rebuild it.

Even with some insurance options available, your best defense is to avoid treating problematic patients when possible.

This article was published in Skin Inc. Magazine.

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