PACProvider Posted October 3, 2012 Share Posted October 3, 2012 This is a topic that has been addressed quite often in the forum. Patients want to see a doctor rather than a PA. I am in my first job in a clinic with PAs, NPs, MDs and DOs. At least once a month, some patient is put on my schedule who erupts in a rage when I walk into the room and introduce myself as a PA. Please understand that they were told they would be seeing a PA before I entered the room. Still, I get that rare one each month who blows up before I have a chance to speak a single word beyond the introduction. Initially, I simply said "you have the right to choose your provider." I then arrange for the person to be rescheduled and get their copay back. Now, our clinic manager, an RN, is telling me that I have to stay in the room with the patient and persuade them to utilize the services of a Physician Assistant. My SP has agreed with her and tells me that I must continue to pressure the patient to allow me to conduct the HPI, physical exam, ROS, write orders and referrals and promise the patient that they will see a physician at another visit. THe fact is that the patient may not see a physician for 3 to 6 months at our clinic. I have tried to explain to my SP that this could be a source of trouble from a litigious patient who felt coerced, manipulated or put under extreme duress to see a provider that they explicitly stated they did not want to see. My SP rejects the idea that this is a possible legal risk for me. I am wondering if anyone has experienced this. I always was taught that when the patient makes their wishes clear (as they have in each of these cases), the PA must offer to help the patient find a different provider that meets their requirements even though the timeframe may not meet the patient's expectations. Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted October 3, 2012 Moderator Share Posted October 3, 2012 the correct (and honest) answer it sounds like is " the doctor does not have any available appointments today. I can see you right now or the doctor can see you in 3 months". the other part of this is folks need to know up front when they make the appt who it will be with. all their reminder cards etc should say "you have an appt with john doe, pa on october 2nd" so when they fly into their rage you can show them all the chances they had earlier to request a doc. in the er when someone pulls this we say "sure you can see the next available doc". 3 hrs later when the doc comes in and says "the pa really should suture this complex lac because they do this more than I do" you just smile..... Link to comment Share on other sites More sharing options...
tigerlily Posted October 3, 2012 Share Posted October 3, 2012 The primary care provider for both my kids is a PA. I always have ancillary staff tell me we are seeing a doctor, at least 2 or 3 times each visit: once when I call to schedule the appt, once when I check my kids in, and once by his nurse. My provider doesn't know this, so what I'm saying is that it is possible someone is in fact telling the patient they will be seeing a doctor. I'm not saying it is the case at your workplace, but it is possible, and it would be an easy fix to a lot of unnecessary heartache for everyone. Have you asked your patients who told them they would be seeing a doctor? Link to comment Share on other sites More sharing options...
surgblumm Posted October 3, 2012 Share Posted October 3, 2012 The best and most honest response. bob Link to comment Share on other sites More sharing options...
PACProvider Posted October 3, 2012 Author Share Posted October 3, 2012 Thank you. I agree that this problem would be solved if the clinic manager who supervises the front office and medical assistants (indirectly through another chain of management) would take a responsible approach to fully inform patient. It doesn't seem to be happening despite my best efforts to communicate this to her (the manager) and my SP. The problem remains with the patient who is told by me, "I can see you now or you can see a doctor in a few months." That patient will continue to express rage, anger, insults, and all forms of abuse. My SP insists that I remain in the room and try to persuade them to see me. In my view, a simple statement that "I can see you now or you can see a doctor later" should be followed with a "yes" or "no." Instead, I am being tasked with customer service for angry patients whom I was not the one who made them angry in the first place. It still makes me feel unsafe on legal grounds to try to pressure someone to see me even after they make their intentions clear. It seems like I'm being asked to act like a hard sell used car salesman. That's not me and not why I practice medicine. Link to comment Share on other sites More sharing options...
pa2ed Posted October 3, 2012 Share Posted October 3, 2012 I worked for 10 years in an internal medicine office. Several times a week a patient would come in and be upset I saw them rather than the doctor. I found that many patients made an appointment with me just to get into the office then demand to see the doctor. We accomadated that for a while but were way too busy so, I developed an approach. "I am sorry for the scheduling misunderstanding. Were you not informed you were seeing me today? No? I want to assure you our scheduling staff has been directed to make sure each person knows exactly who they are seeing for the appointment when it is made! I am happy to see if the doctor is available. " (Leave room, come back several minutes later, maybe even see another patient) "I am sorry, the doctor is triple booked today. I can continue with you right now, knowing that I will discuss your case with Dr. so-and-so this evening. If that is not acceptable, I can have our secretary reschedule you with the doctor". Sometimes it worked, sometimes not. We did lose a few patients but, after a few months patients got to know me and it was a non-issue. Link to comment Share on other sites More sharing options...
Acebecker Posted October 3, 2012 Share Posted October 3, 2012 I have had this happen on several occasions. Most recently my reply has been this: "I'm sorry for the scheduling mix up - I certainly understand and agree with your right to see a physician. We'll work on that. In the meantime, let me ask you this: is there something that our PAs or NPs haven't done for you in the past that you feel has led to problems?" This approach could go either way - they may either say, "Yes, PAs/NPs are terrible and have missed things," to which I respond, "Ok, that's fine. Let me get started and I'll get you the next available appointment and I'll see if you can be double booked somewhere," or they'll stumble around, stair at their toes, and scuff at the floor while they sheepishly reply, "No... Not really." So far, no one has had a problem with seeing me after I ask them up front: what's your problem with seeing PAs? YMMV Andrew Link to comment Share on other sites More sharing options...
discogenic Posted October 3, 2012 Share Posted October 3, 2012 I have had this happen on several occasions. Most recently my reply has been this: "I'm sorry for the scheduling mix up - I certainly understand and agree with your right to see a physician. We'll work on that. In the meantime, let me ask you this: is there something that our PAs or NPs haven't done for you in the past that you feel has led to problems?" This approach could go either way - they may either say, "Yes, PAs/NPs are terrible and have missed things," to which I respond, "Ok, that's fine. Let me get started and I'll get you the next available appointment and I'll see if you can be double booked somewhere," or they'll stumble around, stair at their toes, and scuff at the floor while they sheepishly reply, "No... Not really." So far, no one has had a problem with seeing me after I ask them up front: what's your problem with seeing PAs? YMMV Andrew Provided they have a good understanding of what PAs can do. If they are confusing you for the Medical Assistant, then I'd imagine they would have a problem. Link to comment Share on other sites More sharing options...
PAstudentCanada Posted October 4, 2012 Share Posted October 4, 2012 My supervising physician has instructed is receptionists to tell people when they book with me that they will still get to see him but have to see me first. So patients come and, sometimes, probably about 3-4 pts per week, will say "i just want to talk to the doctor but they told me I have to see you first" so they are using me to get to him. I exlained to my SP and to the receptionists why this is problematic but my SP responded "if we don't tell them that, they won't come" to which I responded "what's the point in them coming if they refuse to interact with me when they get here?" to which he responded with "i am not discussing this anymore" and changed the topic. Link to comment Share on other sites More sharing options...
bgdog Posted October 4, 2012 Share Posted October 4, 2012 At least once a month, some patient is put on my schedule who erupts in a rage What?? Serious? Rager would get thrown out of the office, lickety split, or goodbye PA, period. Now, a polite discussion as to who the pt was going to see and an inquiry into the miscommunication is totally appropriate, but rage, oh hell no. A couple of insights. This doesn't happen to me, because when I enter, I "own the room". I am confident, direct, and there to take care of business. I don't ask permission, I do what salesman have done for years, I assume the sale, meaning, there is never any doubt in my mind that I am going to see the pt. Albeit, I am 6'2" 200lbs, Italian, over 50 and have many years of direct pt contact. If you don't possess those qualities then it's time to learn. A good friend is a PA with one year experience, 5'2 100 lb. female, and when she enters the room, she means business. She is so "on her game" it ain't funny. Grown men tremble, not because she a b$#ch but because she just knows her stuff. So the point is, being strong and confident in who you are with a mindset of completing whatever you set out to do, permeates your being, and things fall into place. good luck Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted October 4, 2012 Moderator Share Posted October 4, 2012 . Albeit, I am 6'2" 200lbs, Italian, over 50 and have many years of direct pt contact. If you don't possess those qualities then it's time to learn. How do I learn to be 6'2'' , 200 LBS, and italian? elevator shoes and lots of pasta?.....:) Link to comment Share on other sites More sharing options...
bgdog Posted October 4, 2012 Share Posted October 4, 2012 How do I learn to be 6'2'' and italian?elevator shoes and lots of pasta?.....:) Well...gold chains don't hurt either. Link to comment Share on other sites More sharing options...
OpSite Posted October 4, 2012 Share Posted October 4, 2012 Well...gold chains don't hurt either. Hahahaha!! Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted October 4, 2012 Moderator Share Posted October 4, 2012 Well...gold chains don't hurt either. I pity the fool....(in Mr T voice....) Link to comment Share on other sites More sharing options...
d2305 Posted October 4, 2012 Share Posted October 4, 2012 And a diamond pinkey ring. I don't have that problem in my walk in clinic as there is no doctor to see, just me. Link to comment Share on other sites More sharing options...
Joelseff Posted October 4, 2012 Share Posted October 4, 2012 The last 3-4 posts made me LoL so hard I almost spilled my coffee...thanks guys Sent from my myTouch_4G_Slide using Tapatalk Link to comment Share on other sites More sharing options...
jen0508 Posted October 4, 2012 Share Posted October 4, 2012 every so often i run into this issue and this is generally how it goes "hi. i'm jen0508, i'm the PA here in the ED, nice to meet you" patient: "so i'm not seeing a doctor?" "No, i'm a PA. I'm your provider today. so what brings you in today?" usually they will look at me with a blank stare for a couple seconds, then start talking about their complaint every so often they ask what a PA is/does and i give them the spiel "i will do your history and physical exam, order appropriate tests and interpret them, diagnose and then treat you, including writing your prescriptions" when they hear "write your prescriptions" thats usually all they care about. its been 2 months and i've never had anyone demand to see a doc. Link to comment Share on other sites More sharing options...
PAstudentCanada Posted October 4, 2012 Share Posted October 4, 2012 And a diamond pinkey ring. I don't have that problem in my walk in clinic as there is no doctor to see, just me. Shouldn't you wear the ring on your index finger while doing DREs? Link to comment Share on other sites More sharing options...
Guest carolanimal Posted October 4, 2012 Share Posted October 4, 2012 Thank you. I agree that this problem would be solved if the clinic manager who supervises the front office and medical assistants (indirectly through another chain of management) would take a responsible approach to fully inform patient. It doesn't seem to be happening despite my best efforts to communicate this to her (the manager) and my SP. The problem remains with the patient who is told by me, "I can see you now or you can see a doctor in a few months." That patient will continue to express rage, anger, insults, and all forms of abuse. My SP insists that I remain in the room and try to persuade them to see me. In my view, a simple statement that "I can see you now or you can see a doctor later" should be followed with a "yes" or "no." Instead, I am being tasked with customer service for angry patients whom I was not the one who made them angry in the first place. It still makes me feel unsafe on legal grounds to try to pressure someone to see me even after they make their intentions clear. It seems like I'm being asked to act like a hard sell used car salesman. That's not me and not why I practice medicine. Is there anyway that perhaps patients at your clinic can sign some sort of acknowledgement that they know that they will be scheduled with a PA first, that they know what a PA is capable of, that they may have to wait months for a doctor to see them otherwise, etc? I agree that this seems like something that could make you vulnerable to some sort of legal risk. Link to comment Share on other sites More sharing options...
jmj11 Posted October 4, 2012 Share Posted October 4, 2012 Hmm. I've been in your shoes and it is painful and frustrating to be rejected before you've had a chance to show them what you can do for them. I, of course, don't have that problem now as this is my practice and they come here to see me specifically. I do remember how it was when I worked at a "world famous clinic" where people came from far away. They would react just has you described sometimes. I hated to try and see someone who started the visit in anger. However our department had a policy that you see who you see and you can't switch providers. This pertained to MDs. I was the first PA in the department. The head of our (70 physician) department wanted me to say when I walked in the room, "Hi, I'm so and so the PA. You have the right to see an MD and I will help you make that arrangement if you wish." (sort of like the Miranda rights). However, when my boss (the boss of our sub group of 6 providers) heard this, he was livid. He, btw, was an extremely good SP, about the best I ever had. His view was that the policy about physicians should apply to me. If I gave the patient the option of seeing someone else, so he reasoned, then it would imply that the quality of care varied among providers. He rejected that notion. So if a patient refused to see me, and they did about once every few months, they were treated the same way as if they rejected seeing one of the neurologists ( and sometimes they did for stupid, prejudicial reasons like the neurologist was foreign born, a woman, a person of "color") their appointment was cancelled and they were put in the back of the line. That meant they had to reapply and see, if they were one of the 10% chosen to come the next time the lottery is spun. Then if they do come back, it would be months later and they would be randomly assigned to the expert in that area . . . which could be the same person they were scheduled with the first time. But in the typical clinic situation, I know that things can be different. It is hard to dance with a partner who hates you because the way your name is spelled. Link to comment Share on other sites More sharing options...
emfdj Posted October 4, 2012 Share Posted October 4, 2012 I work in an urgent care where the physicians, PAs and NPs are all "providers". We all split the work load by taking the next patient in line. I only had one patient ask to see the physician. It was the first patient of the morning and I just wasn't on my game due to home problems. I probably sounded wishy-washy, maybe distracted, under confident. The physician went in and said the same thing I did. The patient was happy and I quickly got my act together. PS I have an Italian last name, maybe that guy just didn't hear it! Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted October 4, 2012 Moderator Share Posted October 4, 2012 PS I have an Italian last name, maybe that guy just didn't hear it! as mentioned above you need the whole deal; 6'2'', 200 lbs, AND gold chains...maybe also "make them an offer they can't refuse" or tell them they will "sleep with fishes" if they don't see you.... Link to comment Share on other sites More sharing options...
jmj11 Posted October 4, 2012 Share Posted October 4, 2012 as mentioned above you need the whole deal; 6'2'', 200 lbs, AND gold chains...maybe also "make them an offer they can't refuse" or tell them they will "sleep with fishes" if they don't see you.... Or was it sleep with the "Snookis" Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted October 4, 2012 Moderator Share Posted October 4, 2012 Or was it sleep with the "Snookis" either way there is a fishy odor..... Link to comment Share on other sites More sharing options...
Contrarian Posted October 4, 2012 Share Posted October 4, 2012 either way there is a fishy odor..... LMBAO.......:heheh: Link to comment Share on other sites More sharing options...
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