If you are a practicing physician, then you have definitely come across patients who want something that you feel is unnecessary. Sometimes those conversations escalate and become contentious, and sometimes you reluctantly give the patient what they request even though you know it’s not “best practice.” These demands and interactions can weigh on us and leave us emotionally drained.
In the pediatrics office, that can look like this:
- A parent wants an antibiotic for what you know is a viral illness.
- A parent wants ADHD or anxiety medication before you’ve completed a full assessment.
- A parent wants blood work, imaging, or a referral that you feel is unnecessary.
The list could go on and on. Regardless of your specialty, I’m sure you can think of a few of your own. What’s a doctor to do? One thing we can’t do is stop the requests from coming.
So what can we do? Stop focusing on the patient and shift your focus inward. When you learn how to manage your response to these ever-increasing requests, you can protect yourself from being angered or drained by them, and you might even strengthen your relationship with the patient and influence their future requests.
Here are three ways these conversations can go. Which one sounds most like you?
You let the requests anger or annoy you. This leads to confrontation and escalation. When you are upset by the request, you respond in “unfriendly” ways. You dismiss the parent’s request in a rude, short way. In this scenario, you believe that what the parent is requesting is unnecessary. You are annoyed with the request. You think the patient should listen to you. You feel you don’t have time or energy to entertain the conversation. You might be right on a clinical level (you probably are), but when you communicate with the patient from this emotion, you come off as condescending and rude, and they will respond in kind.
You let the requests deflate you. You feel helpless, defeated, exhausted. As a result, you give the patient what they want without any discussion. This typically happens when you feel like you can’t win. You don’t have the time or energy to engage in a conversation and even if you do, it’s exhausting to explain it all, and they just won’t listen anyway. What’s the point? Sometimes you feel manipulated or fear the patient backlash if you don’t give them what they want. No shame here. We’ve all been there. This leaves you feeling hopeless and manipulated and can lead to poor patient care as well as disengagement and burnout.
You get curious about the request. You approach the request with a curious, open mindset and a willingness for shared decision-making. You ask questions and don’t take the request personally. When you find out where the request is coming from, you can address the underlying issue (which is usually fear). You hear, “My neighbor had this symptom, and it turned out to be a brain tumor,” or “I’m a single mom, and I just haveto get him back to daycare.” Understanding the why allows you to approach the conversation with compassion and mutual understanding.
Once you understand what’s behind the patient’s request, you can calmly plan your response. Each of us has pledged to “first do no harm.” If the request is dangerous, you need to say “no.” But you can be firm, clear, and kind with your “no.” If the patient feels you have truly listened to, heard, and addressed their underlying fear, they will frequently agree with your advice. But even if they don’t, when you approach the conversation this way, it rarely escalates into a confrontation or a personal sense of despair. If the request is in the gray zone, there is space for shared decision-making even if it’s not textbook “best practice.” The “art” of medicine allows us to consider the context when we make clinical decisions.
If you’re anything like me, you see yourself in all of these scenarios. Some conversations are just not going to go well. Don’t dwell. Learn and grow and give yourself some kindness along the way!
Jennifer Shaer is a pediatrician and chief wellness officer, Allied Physicians Group, and a certified executive and life coach. She is founder, Shaer Coaching, and can be reached on Facebook. She is available for one-on-one coaching and speaking engagements: Feel free to schedule a conversation with Dr. Shaer or reach out by email.