Why doctors need to be better negotiators

Why doctors need to be better negotiatorsPediatrician Rahul Parikh has a great piece in Salon, Why doctors can’t say no. You should go read it.

In the piece, he cites a recent study showing that, in about 10 to 25% of cases, patients come into an office visit with an agenda, or something specific they request.

It can be an antibiotic, x-ray or a scan, for instance.

The kicker is that patient satisfaction, in part, depends on how a physician handles these requests. And this is especially relevant as Medicare and other private insurers are beginning to use patient satisfaction scores to influence physician pay.

According to the study cited,

Patients who do not have their requests met rate their physician lower, are less likely to adhere to their doctor’s recommendations, and use more healthcare resources than those who do get their request.

Of course, doctors should not acquiesce to every patient demand. Sometimes, saying “no” is in the best interests of the patient. But with time pressures, and now patient satisfaction scores, influencing the office visit, it is becoming easier simply to say “yes” to patient requests.

Dr. Parikh suggests incorporating business skills into the exam room, and call a patient encounter what it is — a negotiation:

… “patient-centered care” or “shared decision-making” are euphemisms for negotiation. And perhaps, like other professionals, we in medicine ought to focus more on negotiation tactics …

Instead of denying a patient request for antibiotic, offer a prescription to take in hand, in case the symptoms don’t improve after a certain period of time. This proverbial “safety-net prescription” is simply a “contingency” in MBA parlance, and can lead to improved satisfaction for both parties involved.

I’ve written before that most doctors don’t receive the requisite business training to navigate today’s corporate-like health care world. The art of negotiation is a business skill that physicians will have to master as we move towards an era of patient-centered care.

 is an internal medicine physician and on the Board of Contributors at USA Today.  He is founder and editor of KevinMD.com, also on FacebookTwitterGoogle+, and LinkedIn.

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  • http://www.facebook.com/profile.php?id=551507097 Seth D Kaplan

    I’m calling BS on your example here.  Although there are times I do use a safety net prescription, it’s not as in the example here.  If a kid has a viral illness, a kid has a viral illness.  So many times parents just want an antibiotic prescription, but it’s completely inappropriate.  If their symptoms don’t improve, they need to be reevaluated.  I can’t tell you the number of times a family has given left-over amoxicillin because they thought they needed it, despite the fact it only has a shelf-life of 14 days.  Bad example of how kowtowing to the need for patient satisfaction can lead to bad medicine.

    • Anonymous

      I think the point is “negotiating”–in other words, figure out a win-win for both sides.  (Strange to label it that, but that’s the story nowdays)  In the example, I would outline the possible side effects of antibiotics, and give suggestions on other treatments, such as OTC zinc, Tylenol, Vick’s rub, and many others. Maybe blow up a vinyl glove balloon for the kid.  Doesn’t always work, but sometimes going the extra few minutes does help.

  • http://onhealthtech.blogspot.com Margalit Gur-Arie

    If you read the full study quoted in the Salon article, it seems that most “unmet expectations” of patients are directly translatable into time spent with patients. Most complaints have to do with unpreparedness, not taking detailed histories, not asking questions and not providing sufficient counseling. Only a minority of complaints had to do with inability to obtain additional resources, such as tests, referrals and meds.
    Perhaps making sure that physicians have ample time to practice medicine, including time to “blow up a vinyl glove balloon for the kid” is all it would take. Sadly, I think we are marching in the opposite direction.

  • Anonymous

    The underlying problem (as Ms. Gur-Arie has pointed out elsewhere) is the fact that satisfaction scores, as currently calculated, should have no more influence on a doc’s pay that they do for congressmen, defense contractors, highway builders, and so on.

    One would expect our medical societies to be vigorously pointing this out, but instead, CMS and the large insurers say “Jump!” and they ask “How high, Sir?”

  • Charles Knight

    So Medicare wants to cut physician pay based on patient satisfaction while essentially cutting the amount of care delivered through “reform?”
      And some kind of ill-defined business training is going to help with this?What a joke!  It won’t work.  The only “negotiating” that can be done will be opting out of Medicare, or getting out of Medicine, or leaving the U.S!   
      Actually, we should probably sue CMS for this reprehensible attempt, and throw out all the politicians who back it!

  • http://twitter.com/LittlePatient Haleh

    I would like to take your article one step further: “Why Docs Need to be Better COMMUNICATORS”. 

    To be an effective negotiator you truly need to connect with and communicate effectively with your patient.  It’s not about handling the business of medicine- it’s about how to be an effective healer (which in turn will increase business)  To be an effective healer you need to “get” people- so they open up to you and you can gain their trust.

    Haleh Rabizadeh Resnick, Esq., Speaker, Author of Little Patient Big Doctor
    http://www.littlepatientbigdoctor.com

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