Pediatrician 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.
Kevin Pho is an internal medicine physician and on the Board of Contributors at USA Today. He is founder and editor of KevinMD.com, also on Facebook, Twitter, Google+, and LinkedIn.