Scripted responses to difficult phone conversations with patients

[BlueLightRN]

Anyone have any responses they use they'd like to share? I have to call patients frequently and explain things they don't want to hear. Their meds were denied by insurance and we had to change. No, they can't have the narcs they want. No, they need an appointment and can't just "have whatever they requested called in" and "No, anxiety and depression don't qualify you for medical cert" to keep their lights and gas turned on. No, they need to be seen for birth control, antibiotics, etc., etc. And lots of other situations. Any other nurse who has to deal with rude/angry patients on the phone, let's hear it!

"Unfortunately your provider is unwilling to send a prescription for you to your pharmacy without seeing you in the office, so I am calling you to schedule an appointment for you. What days are convenient for you to come in?" and "No, we do not have anything available today." and "If the pain/congestion/whatever is so severe that you have tried everything and nothing helps and you cannot wait to see your doctor, it may be wise to get an (x-ray, examination, whatever test) or be seen in the ER to rule out any serious problems immediately.

[meanmaryjean, DNP, RN]

I am a HUGE fan of scripting - even in the hospital. We are going through a huge hairy deal getting parents to comply with isolation procedures, and I am BEGGING for a script so that EVERY family hears the SAME message EVERY shift.

[littlekaneRN]

This is highly relevant to my position! So happy it was posted, I'd love to hear some good scripts :)

The only thing I have scripted in y own way is when I call about a skin cancer dx

[BlueLightRN]

I don't call patients with any diagnosis of cancer, I don't feel it's right for them to hear over the phone and what if they freak out and off themselves? Huge liability. I also don't tell patients over the phone if they have herpes, syphilis, hepatitis or HIV, it's something they need to hear in person. I wish there were a good script for calling them. Currently I say something along the lines of "your doctor has asked me to call you to come in and discuss your test results so I am calling to make an appointment with you, what times or days are good for you? Of course, they know what they got tested for and just ask for the results over the phone but I am not okay with telling them, so I say something like, your test results are released to your provider and not to me but he/she has asked me to call you so he/she can talk to you about them. They are almost always not okay with that so I wish I had something better. I get tired of basically arguing with people on the phone.

[T-Bird78]

Sounds like you've got it covered. If in doubt, just say the doctor will go over your results at your appt, I do not have access to that information. As far as meds being denied, blame the insurance company and the pt can call their ins and ask about it also. They pay for a service they're not receiving so they can definitely call the insurance for more info. :)

[newrnltc]

yes! for the pts that are able, I love to refer them to the member service number for their insurance. after ive exhausted all my resources calling in, writing appeals etc. if meds or procedures are still denied i let the pt know. more than once the pt was able to get an approval. it is especially nice to send those special pts (the loud/demanding ones) - had one such pt tell us she got up to the medical director level and gave him a piece of her mind. approval was faxed to our office the next day lol

[BlueLightRN]

The patients we serve are usually about illiterate and lazy/demanding/entitled (sorry but it's true) and a lot of times say "well isn't that your job?" or "can't you just do it" when I tell them they need to call their own insurance companies. In my head I'm thinking, yeah and when you're in our office at your appointments I'm always in taking care of you or answering your questions or you're asking for a drink and a snack and you want this and that and 20 other things, so no, I can't just spend 40 minutes calling them, I'm busy lol.

[BlueLightRN]

Do any of you guys deal with the narcotic seekers on the phone? What kinds of things do you tell them when you know the doc is going to say no (patient with illegal drugs in tox screen, multiple pain violations, etc., etc. But they just keep begging and asking and get so mean and nasty!

[mama2]

for those truly special patients, I say, (in my sweetest voice) "I understand how frustrating this must be for you, and I'm truly sorry that I am unable to get you what you are asking for. Let me transfer you to our practice manager, perhaps she can assist you further".

[xoemmylouox, ASN, RN]

Sometimes there is nothing you can say or do to calm them down. I've had MD's and my manager get on the phone to just become so fed up with the verbal abuse they disconnect the call. I have found most often that speaking in a calm and understanding voice helps. Listen to their complaint/concern and confirm what their issue is. Follow up is important as well.

[CrunchRN, ADN, RN]

You just have tell them straight out what they can or cannot do/have. Be polite and non-judgemental. If they get ugly you have to tell them that you will end the call unless they are polite and then hang up if they continue. Document that in the chart. If they continually drug seek or are abusive you need to have the practice manager discharge them from the practice. This requires a letter that gives them 30 days notice.

[Altra, BSN, RN]

I absolutely agree with the post above.

Over the years I have observed that many difficult conversations are made more difficult by "talking too much". It is not impolite to simply state, "no I am unable to do that for you." And STOP. TALKING. A moment's pause allows it to sink in that they're going to have to cope with the situation and deal with it. AFTER that pause, if appropriate, is the time to offer "what we can do is (blah blah blah)"