True story: A patient of our pharmacy for whom we prepare blister packaging had a job that brought her out of town a few times per month, causing us to transfer her prescriptions back and forth to anther pharmacy. Each time required reconciliation, transcription error risk and an unpredictable halt of our workflow since she was not the most organized. She would arrive without notice, impatiently requiring her complex blister packages and storm out of the pharmacy when we communicated that we needed time to transfer her prescriptions back in and prepare her order.
The unplanned transfer requests went back and forth over a few months, each time with confrontation and stress until we did not have a drug in stock. The patient yelled at the staff and refused to hear how she could help us make it seamless. Then she marched out, rolling her eyes, slamming the door and placing a one-star review on our Google My Business page.
It was time I ended our relationship. We prepared her next round of blister packs and I called her back explaining that we would deliver today as her last order and asked her which pharmacy I should transfer her prescriptions to.
We were just not that into each other
The patient-healthcare provider bond is an alliance of honesty, understanding and trust. In our best attempts to provide patient care, we sometimes fail to establish the required relationship based on the way a patient treats us or the staff. This can feel like an incompatibility or inability to connect in a collaborative way.
In my experience, it seems that those patients have often found it difficult to establish that same relationship with other pharmacists before me, as seen by their transfer history or the unusually far travel distance between your pharmacy and their home address. I am willing to bet that they may also find conflict at other stops on their errand list like the grocery store, bank and coffee shop.
Like square pegs in round holes, they can, unfortunately, find it hard to fit into the positive culture you are trying to create, bringing an opportunity cost by way of staff stress, distraction and job un-satisfaction.
By avoiding the potential conflict involved in showing them the door, you are doing a disservice to them, your staff and the patients you could be helping otherwise.
While the loss of this patient brings reduced stress and culture improvement, there is another undervalued and intangible benefit.
Organically, having the boss act in defence of the staff demonstrates that the person in charge is willing to defer immediate business revenue to provide a positive and supportive atmosphere to their employees. This shows them unconditional loyalty and proves that you will take the bullets for them in times of war. This paves the way for them buying into your philosophy, making the team stronger and more capable of caring for its patients.
How can pharmacists discharge a patient?
The discharge is the last resort after reasonable efforts have been attempted and it is executed with patient dignity intact. We must clearly communicate an avenue to receive care elsewhere by offering to seamlessly transfer their prescriptions to another pharmacy, within a reasonable timeline.
Some talking points might be:
“It seems we have been unable to meet your needs and will not be able to fill your prescriptions after today. Where would you like me to transfer your prescriptions to? A fresh start could be best for everyone.”
Politely giving them options puts them in the driver’s seat, making them part of the solution, whether they take offence to it or not. Setting up a seamless transfer is part of our standards of care. Ensure any loose ends are tied before cutting the cord such as owings, items on special order, open recommendations to their prescriber or related prescription pickups.
Part of the transition may even include a conversation with the receiving pharmacist offering a suggestion in how to prevent a confrontation. In an effort to set up the patient for success in the fresh start, we might share an idea of which topics can be potentially triggering, leaving out specific details of how it did not work with you. By telephone, you can advise the new pharmacist:
“Being clear on wait time expectations and ensuring you have her medications in stock at all times will help prevent challenges.”
Purging negatives is a net gain
Sometimes in business we need to lose in order to win. In the case of an incompatible patient, it is our job to recognize when it is time to part ways. Once that has been determined, collaborating on a seamless plan for someone else to take over care is essential, opens doors for staff buy-in, and presents opportunities for new business.
Like a renovation, discharging an unfit patient is immediately strenuous but worth it in the end.
Jason has written about dealing with patient criticism in a related article.