In this episode, hosts Brad and Michael share the story of two highly respected plastic surgeons facing the same challenge: an unhappy patient demanding a refund after a procedure. While both doctors delivered strong clinical outcomes, their different responses led to very different results. Tune in to learn why your response strategy can influence legal risk, reputation, and the overall impact on your practice. Discover how to evaluate patient disputes, when resolving a complaint may be the better decision, and how a proactive approach can help protect your practice from exposure.
Listen to the full episode using the player below, or by visiting one of the links below. Contact ByrdAdatto if you have any questions or would like to learn more.
Transcript
*The below transcript has been edited for readability.
Intro: [00:00] Welcome to Legal 123s with ByrdAdatto. Legal issues simplified through real client stories and real-world experiences. Creating simplicity in three, two, one.
Brad: [00:13] Welcome back to Legal 123s with ByrdAdatto. I’m your host, Brad Adatto, with my co-host, Michael Byrd.
Michael: [00:19] As business attorneys for health care practices, we meet a lot of interesting people and learn their amazing stories. This season’s theme, Brad, is “What Now?” Each episode will involve a real client story with a high pressure moment for that practice.
Brad: [00:34] Michael, I got to say, today I’m feeling dangerous, and it’s not because I’m on my third cup of hot tea. Something else in the air, I can just, I kind of feel it.
Michael: [00:43] It always feels dangerous when we’re together, Brad, mostly because of you. But it is you. You’re the liability here.
Brad: [00:54] Wow, okay, starting off early today. I like it, but seriously, why have real Brad when you could have digitally trademarked Brad?
Michael: [01:03] I think what I heard you say is less Brad, less real Brad? I’m in total agreement.
Brad: [01:13] I don’t believe I said that. Be careful, Michael. I might trademark my voice, and next thing you know, every time you try to sound smarter than me, I’ll send you an invoice.
Michael: [01:22] That would require you to actually sound smarter first.
Brad: [01:25] Oh, man, I walked into that one. Okay, fair. Michael, I’m working on my AI version of me, and I hope to release it someday to the real world.
Michael: [01:33] Does it keep breaking because it just talks to anyone and everyone it runs into?
Brad: [01:38] That’s a fair point, too. But for those not familiar, celebrities, like myself, are starting to trademark their voices, likenesses, even catchphrases. All this work to counter the AI deepfake, basically digitalizing or digitally cloning themselves first and putting a giant, “Do not clone” sticker on their faces.
Michael: [01:57] Oh, well, your humility knows no bounds, Mr. Celebrity. But I do like the idea of putting a giant sticker over your real face, though.
Brad: [02:06] Oh, man. Walked into that one, too. Okay, well, you’re right, actually. I do have a great radio face. Listen, if anyone is digitally cloning me, I want royalties first, and if you’re making a clone of Michael, please make one version, at least one, that shows up to meetings on time.
Michael: [02:22] I don’t think AI is capable of that yet.
Brad: [02:25] Fair. But seriously, this is really getting interesting, Michael. You got people like Taylor Swift trademarking phrases like, “Hey, it’s Taylor,” and Matthew McConaughey locking down his voice clips, which honestly, if someone’s impersonating Matthew, they have to do the “All right, all right, all right” correctly, which I don’t think I did correctly, Michael.
Michael: [02:46] Groan. Dad joke.
Brad: [02:48] Okay, but here’s the legal twist. The strategy is kind of clever because it’s still untested, so it’s not really an ironclad protection that they may seek to get. It might keep some bad actors away, but if someone really wants to mess with you, they’re probably not afraid that you did a trademark filing.
Michael: [03:06] Yeah, people that tend to commit fraud on the public don’t spend much time checking trademark laws.
Brad: [03:13] Of course, this actually raises a bigger question, Michael. Can you ever get too much Brad or even digital Brad?
Michael: [03:19] Speaking of walking into it, you just opened the door for my favorite moment of our Boston trip.
Brad: [03:25] Oh no.
Michael: [03:26] Audience, we were having dinner with our friend and client, Steven Camp, who has been on as a guest, and he had the good fortune, kind of, of sitting next to Brad, and at one point he just announced to the table, “Too much Brad.” So I think that there can be too much Brad.
Brad: [03:46] No, I don’t recall that moment at all. I don’t remember anyone ever saying that. But the serious issue is voice, image, likeness. This is becoming a very valuable asset, and actually, believe it or not, lawmakers are trying to catch up. There’s even talk about legislation called the NO FAKES Act.
Michael: [04:04] Well, that’s actually a thing, the NO FAKES Act. You’re not making it up. For those that don’t know, it’s a bipartisan bill which aims to establish a federal right of publicity to protect individuals’ voice and likeness from unauthorized AI-generated digital replicas. I don’t think, as of today’s date, it has passed the Senate.
Brad: [04:25] Yeah. Well, until it’s passed, I will continue beta testing my AI version. Right now, it just nods and says, “Great point, Michael,” about every five minutes.
Michael: [04:40] So it’s accurate as to the real Brad—
Brad: [04:42] I have to work on this.
Michael: [04:43] Yeah.
Brad: [04:43] Yeah, I walked right into that one, too. Well, they better be nice to you, Michael, as I don’t want my digital twin out there causing you problems.
Michael: [04:52] Killing me with dad jokes.
Brad: [04:53] Yeah.
Michael: [04:53] Yes, that’s true. Just relentless. Why don’t we just get into today’s story?
Brad: [04:58] All right, all right.
Michael: [04:59] Okay.
Brad: [04:59] As a reminder, audience members, this season we’re talking about the one big question, “What Now?” Because every successful practice hits a moment where things just don’t go as planned, and today we’ll address what now when one unhappy patient turns into a cascading business problem.
Michael: [05:16] Yes. This happens more than people think, particularly in elective medicine, and this is the type of thing that starts small and can mushroom very quickly into staff stress, online reviews, regulators, and lawsuits.
Brad: [05:34] Yeah, and the key distinction here we’re going to explore is not just what happened, but how the doctors respond to it. In today’s story, we have two brilliant surgeons and how they handle this type of challenge completely differently. We have two partners. One’s Dr. Matthew, one’s Dr. Taylor, both nationally recognized plastic surgeons, both incredibly skilled, top of their game. They do speaking engagements, have stellar reputations, and strong revenue.
Michael: [06:00] I can’t stop picturing Matthew McConaughey and Taylor Swift in scrubs right now. But I think that was appropriate use of names based on our opening.
Brad: [06:09] Awesome. All right. Good. But very different philosophies between these two physicians. Enter our first unhappy patient. Let’s just call her Lisa. Lisa had a cosmetic procedure. Expectations didn’t match reality. She’s upset. She comes back to the practice complaining, demanding a refund from Dr. Matthew.
Michael: [06:26] Yeah, I think I mentioned this a moment ago, just how common this scenario is, and it really does come down in plastic surgery that most of the time it is an elective procedure. In other words, this person is making a choice to have someone cut on them to make them look better. And so the expectations that come with that can be out of line with reality. And so it’s just a ripe situation for an unhappy patient, even when you have a great clinical result.
Brad: [07:00] Yeah. So after hearing Lisa’s demand, Dr. Matthew started to evaluate the situation. He was frustrated as the outcome was excellent, again, clinically speaking, but he knew that he could not just evaluate this from an emotional perspective. He needed to take a step back and think bigger picture, like what impact it could have on his reputation, risk, his staff, and the costs of this escalating. And what he had started doing a while back was setting aside a kind of business judgment reserve, where he put money aside—otherwise you might call it a slush fund—so he always had a certain amount of money available.
Michael: [07:42] Yeah, I remember this conversation from some time ago, and he would set money aside. He had a reserve set aside for stuff like this. In other words, he’s budgeting for the reality that not every patient believes their outcomes are perfect, and sometimes resolving a problem quickly is the smartest business move, even if it doesn’t feel good from a fairness perspective.
Brad: [08:10] Yeah, exactly. In fact, Dr. Matthew had a previous conversation with our firm on the strategy of dealing with these types of requests. So when Lisa made this request, he had a plan. He didn’t let his ego or desire to win cloud his thinking. After thanking Lisa for her feedback, he actually agreed to refund the medical services, and she had to execute a refund agreement on behalf of the practice. In his mind, this offered a reasonable solution, kept the interaction calm, and everyone was able to move on.
Michael: [08:43] Yeah, you mentioned refund agreement, and this is typically not just, “Here’s your money back as you requested,” but if we’re going to give you this refund, we want certain conditions to go with it, including a release and some other protections for the practice that brings closure. I’m curious, just based on how you set this up, did Dr. Taylor have a different mindset?
Brad: [09:08] Well, you know the answer.
Michael: [09:09] I know.
Brad: [09:10] Yes. Very rules-driven was Dr. Taylor. Every request must be proven, every issue must be defended, which sounds great until, as you said earlier, real life shows up. Unlike how Dr. Matthew handled his patient, Dr. Taylor chose a different path. She had a patient we’ll call Sammy who followed the same story. Sammy had a cosmetic procedure. Expectations didn’t match reality. She’s upset. She comes back to the practice complaining and demanding a refund from Dr. Taylor.
Michael: [09:43] Yeah, and going back to how common this is, we actually have clients where there are multiple surgeons, and they may be dealing with multiple unhappy patient situations at the same time. It’s just a business reality for treating patients, especially on the elective side of things.
Brad: [10:08] Absolutely. And Dr. Taylor did not get emotional about the request. She refused the refund, as that was not her policy, and clinically, again, the surgery was a success.
Michael: [10:19] So she sounds like she had a plan and stuck to it.
Brad: [10:22] Right. By refusing the refund, Sammy started getting emotional.
Brad: [10:26] She started by calling the staff and repeatedly messaging them, and finally started lashing out by posting negative reviews on multiple platforms.
Michael: [10:36] This is the mushrooming effect I was talking about. It can get ugly fast when the patient starts spiraling.
Brad: [10:42] Yeah, and Dr. Taylor stays the course and refuses to pay and starts becoming a bit more stressed around the entire practice as Sammy has become a very disruptive patient.
Michael: [10:53] To take a step back, the thinking that usually goes behind a policy like this that Dr. Taylor’s following is, if you believe you did nothing wrong and then you give a refund, you will develop a reputation for doing this, and the floodgates will open. We have definitely had clients with this view on making refunds over the years.
Brad: [11:15] Yeah, the stress has the entire practice on edge now as Sammy is trying to get other patients of the practice to also start posting negative reviews. At this point, Dr. Matthew’s team is also getting stressed as they now worry about the negative actions that will impact patient flow.
Michael: [11:35] Yeah, it can get really ugly. We’ve seen patients go really extreme in this effort to be heard, and we’ve seen building dedicated websites, posting blogs, calling the doctor names like The Butcher of Los Angeles or some insert city. And Brad, just as a tip, it’s not good to be a surgeon and to be described as a butcher.
Brad: [12:07] Mm. Fair point. I’ll keep that in mind. Well, based on the feedback from the entire team, Dr. Matthew decided to speak with Dr. Taylor about finding a resolution to this matter and not allowing this to continue to escalate the way it was going.
Michael: [12:23] Yeah, I’m sure he’s concerned, as you mentioned, about what’s the blowback to him, but also the practice itself. If it’s exposed, it can eat into his revenue stream.
Brad: [12:42] Yeah. So Dr. Taylor, fortunately or unfortunately, however you want to look at it, disagreed and dug in. She explained she was operating from a place of control, that her policy was not to refund good work, and that the rules should apply no matter the patient and the stress that comes from it.
Michael: [13:02] She had a plan, and she was sticking to it.
Brad: [13:04] Yep. And so Dr. Matthew disagreed, but based on how the governing documents were put together and how they ran their practice, he could not force her as a partner to change that plan. And the calls and emails from Sammy continued for a while, but eventually they stopped.
Michael: [13:23] Ah, relief. She just finally decided to move on to somebody else, I’m guessing. Must have been a relief for the practice.
Brad: [13:31] It was, until they later learned why Sammy stopped. Sammy had hired an attorney who filed a malpractice case against the practice and Dr. Taylor.
Michael: [13:42] Womp, womp. I guess that’s what we would call an escalation.
Brad: [13:46] Yes. And suddenly the cost of standing her ground had multiplied, and now she needed to get her medical malpractice carrier involved.
Michael: [13:55] Yeah, audience, one of the first things you have to do if you get sued as a surgeon is notify your carrier, and they will step in and provide the defense. The good news is that’s what you paid for. The bad news is your premiums are going to go up over time as you have a claims history, so it’s not insignificant from a financial cost.
Brad: [14:31] Yeah. And on top of everything else, Dr. Taylor, who had created this false sense of security, now needed to spend more time, resources, and energy on this lawsuit.
Michael: [14:42] Can’t overstate what you just said, Brad, because that’s the big one. Just think about all the time Dr. Taylor has already spent holding ground and dealing with escalation. In a lawsuit, it’s not just the lawyers running it while you continue working—it takes time and energy, and it’s a real distraction both professionally and personally.
Brad: [15:16] Yeah. So Dr. Matthew recommended they settle this lawsuit as soon as possible and move on. But guess what Dr. Taylor wanted to do.
Michael: [15:25] I’m guessing she didn’t.
Brad: [15:29] She did not want to settle this. You’re correct. She checked all the boxes correctly in surgery, and she did not want to settle it with a bad patient.
Michael: [15:38] Holding firm. All right, let’s go to break and learn what happened to Dr. Taylor and the practice.
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Brad: [16:19] Welcome back to Legal 123s with ByrdAdatto. I’m your host, Brad Adatto, with my co-host, Michael Byrd. Now, Michael, this season our theme is “What Now?” And in this show, we’re really trying to explore what happens when a patient complaint occurs.
Michael: [16:35] Yeah, and we have Dr. Taylor and Dr. Matthew, two partners in a practice who have different strategies for dealing with this situation, and we got to see this play out in real time. It really illustrates the differences. On the one hand, Dr. Matthew had met with you and had a strategy. He had a business reserve fund and was very intentional about risk management.
Brad: [17:10] Yep.
Michael: [17:10] And he decided that was his priority so that he could focus on creating revenue and avoid time distractions. So when the situation arose, he was prepared to deal with it. Like Dr. Taylor, he had a good clinical outcome, but he recognized that the quickest way to resolve it, based on his strategy, was to use the refund agreement and make it go away. Dr. Taylor, on the other hand, also had a strategy, but it was based on the idea of being right. If the clinical outcome was right, then she was going to stand her ground, and no one was going to take advantage of her. And she did stand her ground, and we saw how that played out. So we ended up with two very different strategies and two very different outcomes, and we can jump from there to talk through the differences.
Brad: [18:16] Yeah. And as you said, same practice, two different stories, two different strategies on how to deal with patient complaints. So let’s start with Dr. Matthew’s response. What was your initial takeaway about how he was acting?
Michael: [18:34] Yeah. He was acting like a Navy SEAL. And this is not outcome-based reasoning just because he got a good result and things went away—it’s about the strategy. He decided that patient complaint risk was something he would have to manage in his business. He consulted with you—may have been a mistake—but at least he talked to someone who claims to be an attorney and came up with a plan.
Brad: [19:06] Probably, yeah.
Michael: [19:07] And then he created financial reserves to support that plan. He was able to stay energy-neutral, which is very difficult in these situations, and not get emotional while making a business decision. So he had a plan, stuck with it, executed it, and got the result he wanted. What do you think?
Brad: [19:39] Totally agree. He was acting like a Navy SEAL. Dr. Matthew saw this as a way to resolve these situations quickly. Not always the cheapest in the moment, but predictable. He had a strategy he could consistently execute. He protected his team—they weren’t overwhelmed—and his reviews stayed intact, without being flooded by negative posts. He also kept his exposure lower because of how he approached it. And it’s important to note that even if he was emotionally triggered by the complaint, he didn’t react emotionally or defensively. He saw it as part of doing business in this space.
Michael: [20:32] Yeah, and it’s important to think about not just speed, but strategy. Moving quickly without a clear strategy can create risk. He might not have achieved the protection he expected simply by acting fast. He could have created the very reputation Dr. Taylor was worried about if he just reacted to make problems go away. That’s why, to your point, acting like a Navy SEAL matters—slow is smooth, and smooth is fast.
Brad: [21:28] Yeah. Agree. When you’re practicing medicine, it’s going to be stressful, and stressful situations will happen. Doctors can react quickly, but if they don’t have a proper internal process of weighing the pros and cons, they will have a blind spot, mostly to their emotions. And so just because you’ve done everything right on paper doesn’t even mean that you’re reducing your risk, which is where we’re going with Dr. Taylor. How do you think she was acting?
Michael: [22:00] Yeah, it’s tricky because you could make the case that she also had a plan and stuck with it. But really, I think she was acting like a cruise director because her plan was based on that sense of right and wrong. Once she decided she didn’t do anything wrong, there was a rigidity to how she ran her business. She stuck to her guns and went all the way through. It’s not just being firm with the patient—she was firm with her partner and didn’t consider the full picture or the pros and cons. That’s one of the dangers: you decide how you’re going to be on something, you stay rigid, and you can’t adjust as the situation dictates.
Brad: [23:07] I think you mean cruise director.
Michael: [23:09] What did I say?
Brad: [23:09] A Navy SEAL.
Michael: [23:10] I said Navy SEAL? Yeah—cruise director.
Brad: [23:12] Yeah. So you said acting like a Navy SEAL, but in this case I agree with you—though I hate agreeing with you—that she was acting like a cruise director, so unfortunately you’re correct again. Hopefully we’re not keeping tabs. But in situations like this, people get caught up in the legal issue and forget to think about long-term business decisions. Sometimes the smartest answer is not about winning or being right—it’s about how to resolve the situation. In other shows, we’ve talked about doctors acting like pirates. We don’t have a pirate here, but how would a pirate handle a patient complaint?
Michael: [23:52] A pirate would react in the moment and do whatever seems right at that time. There’s a complete absence of strategy. You’re going fast and breaking things. Some pirates just give the refund and don’t get a proper agreement with a release. Others might ignore the situation entirely, hoping it goes away.
Brad: [24:31] Yeah, and sometimes they give a refund and don’t realize it’s not the first or last demand. The patient may keep coming back asking for more services or extras. Instead of resolving the complaint, it escalates because now there’s fear: “If I don’t give them more, they’ll file a complaint,” even though you’ve already given money back.
Michael: [25:07] I want to add—
Brad: [25:09] Hold on. Be careful—if you do give extra services or money, make sure you have protections in place for your practice. Go ahead.
Michael: [25:25] Another thing pirates may do is offer a revision surgery. They get caught in the moment and want the patient to be happy, so they offer to operate again—even when there are clear signs that’s a bad idea.
Brad: [25:48] Mm-hmm.
Michael: [25:48] So again, the key issue is the absence of strategy.
Brad: [25:54] Back to our story—Dr. Taylor acted like a cruise director and stayed the course, but the problem festered. The staff absorbed the stress, impacting workflow, culture, and morale. If she had a more flexible strategy instead of rigid control, she could have reduced the overall impact on the practice and her finances.
Michael: [26:22] I’ll give you one—that was a good point. What happened with the case Sammy filed?
Brad: [26:31] It was eventually settled nearly a year later, but it caused significant stress for her and the entire practice. If she had paused and asked, “How will this impact me long term?” she might have made a different choice. Sometimes you have to step back, remove emotion, and ask what this decision looks like six or twelve months from now—not just whether you’re right.
Michael: [27:08] Let’s wrap up with final thoughts. When you’re dealing with a difficult patient situation, the question is: “What Now?”
Brad: [27:19] First, remember we’re human, and emotions can take over. Sometimes we lash out or dig in. The key is to de-escalate immediately. Slow down—nothing good happens when you react out of frustration.
Michael: [27:46] That’s exactly right. You need to create space to think strategically instead of reacting defensively in the moment.
Brad: [28:02] Yeah. And we always say great communication starts with listening. So don’t just respond to the patient—actually be present and understand why they’re really upset and what’s truly happening. Because half the time, they don’t want a legal fight or argument. They really want to be heard, and being empathetic and understanding their position may help you in the long run.
Michael: [28:25] Yes. Third—and this is not an easy one for you, Brad—you need to separate your ego from the outcome.
Brad: [28:31] Oh.
Michael: [28:32] This is not about proving you’re right. It’s about protecting your business.
Brad: [28:37] Yeah. So Michael, we’re almost out of time, but winning the argument and losing your reputation is trouble. That’s not good for your practice. Really evaluate those risks. Take a step back and figure out how to make things better before they get worse. And sometimes the cheapest solution is the one that resolves the issue early, even if it doesn’t feel fair in the moment.
Michael: [28:58] Yeah, and coming in with my final thoughts—you’ve heard me say this before in the office and on this podcast—I used to tell my kids there’s only one fair, and that’s once a year in September: the State Fair of Texas.
Brad: [29:16] That’s right.
Michael: [29:17] So fairness is not a good strategy for protecting your business. You want to have a plan—you don’t want to make it up as you go. You need a framework: who handles complaints, when issues escalate, what actions you’ll take, and what tools you’re willing to use. Consistency and planning reduce chaos and lead to stronger protection.
Brad: [29:53] Absolutely. Well, audience members, that’s all the time we have. But don’t worry—we’ll be back next Wednesday to address, “I have a cash flow issue. What Now?”
Brad: [30:05] Thanks again for joining us today. And remember, if you liked this episode, please subscribe. Make sure to give us a five-star rating and share with your friends.
Michael: [30:11] You can also sign up for the ByrdAdatto newsletter by going to our website at byrdadatto.com.
Outro: [30:17] ByrdAdatto is providing this podcast as a public service. This podcast is for educational purposes only. This podcast does not constitute legal advice, nor does it establish an attorney-client relationship. Reference to any specific product or entity does not constitute an endorsement or recommendation by ByrdAdatto. The views expressed by guests are their own, and their appearance on the program does not imply an endorsement of them or any entity they represent. Please consult with an attorney on your legal issues.
