A doctor's appointment may trigger anxiety in patients. Treating an anxious patient may present some challenges.  An encounter may start with a patient stating, "I don't like going to doctors," or more directly, "I'm scared."  They may not extend their extremities for an appropriate examination.  These patients may retract their extremities when a procedure is going to commence. These moments are an opportunity for providers to show empathy to the patient. The unknown can be very debilitating for patients who suffer from anxiety.  It's times like these when patients may benefit from podiatrists who utilize their soft skills. Talking and inserting humor can support a patient who is struggling with fears. Upon becoming aware of a patient's anxiety, one may want to ask the patient about their interests, and by recognizing any commonalities, we may discover an icebreaker that can help the patient feel more trusting. Allowing patients to be engaged in their education about their condition and course of treatment is key. Understand that asking questions that encourage them to open up about their concerns regarding their condition and treatment can result in them being an engaged patient who can validate their needs. In doing so, you may learn that they have heard rumors from loved ones that treatment is painful, which has increased their anxiety. Podiatrists who have taken these steps to build trust with their patients may be more successful in reiterating that they should listen to their providers, not their friends. Providing supporting statements that include the years spent successfully treating these conditions can be valuable. Often, after treatment, you may hear patients say, "You were right. This was not as bad as I thought." Decreasing the patient's anxiety during therapy through the use of these soft skills enhances the ability to provide excellent care by fostering trust and confidence, ultimately leading to improved patient outcomes.

Caregivers may accompany patients for various reasons. Perhaps the patient is a minor and is accompanied by a parent, or the patient is elderly, and the caregiver is supporting them and often coordinating their care. Patients who prefer to have a guardian or spouse present for their appointment can be categorized as challenging. This even involves pediatric patients with their parents.  In some instances, the patient does not speak for themselves, but the other person present does.  I assess these situations to determine why.  There may be physical or psychological issues that prevent the patient from discussing their care correctly.  Children may be scared or shy.  Then, there are instances when the other person present is overly controlling.  Therefore, it is tough to determine the patient's genuine concern and symptoms.  And then, in return, it makes it very difficult to discuss the patient's treatment plan and ensure they comprehend what is expected of them.  In these instances, a good tip may be to speak directly to the patient and maintain proper eye contact. Ask them questions.  If the other person begins speaking on behalf of the patient, it may be appropriate for the podiatrist to clarify that the patient's response is needed at some point.   Eventually, the patient becomes engaged, and a proper doctor-patient relationship is established, enhancing the patient's ability to follow instructions and facilitating effective treatment.

Another example of challenging patients is those who may be dishonest or distrustful. An example is patients who may be informed that their service is considered non-covered, and as such, they will be financially responsible for their treatment.  Inevitably, some patients may ask if their provider could consider coding the therapy in a manner that will allow it to be covered.  Similarly, patients are informed that certain services are only covered after a specific number of calendar days.  A similar situation may occur.  They may ask if we could code something that would allow them to be treated within that period, so that insurance will pay.  In these instances, patients should be informed that the office will not jeopardize licensing or credentialing and that such practices are considered insurance fraud.  They are told they will need to pay out of pocket for such services.  In most cases, this halts any further similar requests. While this sets the tone for an uncomfortable visit, it is necessary and allows the podiatrist to continue treating the patient without receiving inappropriate requests.

Those patients who refuse to follow instructions are sometimes responsible for their troubles. But why?  Some patients fail to listen and often overlook discharge instructions.  Some patients feel they think they know more than the provider.  Sometimes, the cause of noncompliance may be financial in nature.  Many times, we encounter patients with diabetic foot ulcers who are the sole providers for their families and are unable to take a leave of absence from their employment.  Quite often, this is the reason for the noncompliance.  Patients sometimes have no avenue to take time off from work.  Many times, they are unable to use any assistive device to reduce pressure on their affected foot.  

How do we handle such non-compliant patients?  Active listening is paramount in these situations.  Ask questions about employment and if employers can make any concessions to assist their workers.  If patients are not following the provider's instructions, encouraging them to repeat the instructions back to the podiatrist repeatedly can help increase compliance. Additionally, enabling staff to repeat instructions is helpful.  Some offices require patients to sign off on instructions to enhance their ability to comply. These additional steps allow for opportunities for the patient to ask questions. Podiatrists may want to keep a copy of this documentation in their records. All of these extra steps can enhance the podiatrist's ability to ensure their patients receive proper treatment.

Have you tried some of the tips we have provided in this article? Have they been successful? You may have found tried and proven methods that have allowed you to provide the best care to every patient. Look at the patients on your upcoming schedule for the next few weeks. Consider that extra care could result in fulfilling your goal of ensuring that each patient you see receives excellent patient care. It is all worth it in the end!