Indexing Title: RJOSON’s Medical Anecdotal Report [04-6]

MAR Title: Patient’s Dissatisfaction – How to Prevent and Control

Date of Medical Observation: September 28, 2004

Narration:

CC, a 77-year-old female, consulted me for a breast concern.  She was previously consulting a former student of mine (KK), now a faculty in general surgery, and an officer of the Philippine Board of Surgery and Philippine College of Surgeons.  After interviewing her, I learned that she was NOT satisfied with and had lost her trust and confidence in KK.

Background:  CC has a strong fear for breast cancer.  She has been undergoing yearly mammography for the past 5 years.  She has been under the care of KK for the same period of time.  KK had operated on her twice, the first one being two years ago and the latest, a few weeks ago.  The first operation yielded a histopath diagnosis of fibrocystic changes.  The second operation, invasive lobular carcinoma.

My assessment of the situation: CC has a hard time accepting the diagnosis of a cancer to the point that she started finding fault with KK.  She complained that KK was always in a hurry and couldn’t examine her thoroughly.  Somehow, CC’s complaints against KK were valid because I know the KK.

What I did: I tried appeasing CC by depending the medical recommendations and explanations of KK but kept mumped on the actuations disliked by CC.  I tried convincingly her to go back to KK to no avail.  I decided to accept her with caution which included a full and documented explanation of her condition, the options for treatment, comparison of benefit and risk, and an informed consent of whatever we would be doing.

Insights (Discovery, STIMULUS, REINFORCEMENT) / (Physical, Psychosocial, ETHICAL):

One of the goals in patient management is patient’s and relatives’ satisfaction in whatever aspects.  As physicians, we should always strive to achieve this goal in all patients we manage as this is the forerunner of a potential medicolegal suit. 

I had my own share of patient’s dissatisfaction.  I vividly remember two patients whose dissatisfaction resulted from a misunderstanding or distortion of my honest-to-goodness verbal advices.  From this experience, I see to it that I gave my advices in writing ending with the patient or relative signing their choice on the options I gave.

What to do when a patient who is dissatisfied with a previous physician he/she has consulted before transferred to you for management?  Professional ethics dictate at least not to destroy the previous physician’s reputation and not to aggravate the patient’s dissatisfaction against his/her previous physician.  If possible, convince the patient to go back to his/her previous physician.  If not successful, if one can handle the patient’s idiosyncrasies and if one can handle the potential ill-feelings and misunderstanding that can arise from the previous physicians, accept and manage the patient taking care not to fan the dissatisfaction of the patient against the previous physician.