A recent survey of 150 medical society members found, of the members reporting their compensation was linked to patient satisfaction ratings, more than 50 percent believe they were pressured to promote inappropriate care such as unnecessary antibiotic and opioid prescriptions, tests, procedures and hospital admissions.
As medicine trends toward value-based care, how can physicians tell a patient 'no?'
Here are 9 key thoughts:
1. Give other options. If a physician gives a direct 'no' to a patient request such as a test, patients will likely not be receptive to the direct answer. Rather, a physician should try a more diplomatic, less controversial approach such as explaining other options.
2. Explain the why. Rather than cutting a patient off with a simple 'no,' explain the reason behind your decision as well as ask the patient's reason for the request. Often, a physician's role is to debunk the myths surrounding medical treatments.
3. Engage with patients. Physicians willing to start a discussion and negotiate with the patients are likely to receive a better patient response. If a physician articulates his/her perspective well, a patient will likely be persuaded by the treatment option, rather than the one requested.
4. Positive reinforcement goes a long way. Tell a patient what he/she is doing well. If a physician encourages a patient by saying what he/she is doing right, the patient will understand he/she may not need more drugs or whatever treatment they are seeking.
5. Don't be the messenger. It may be beneficial to have another employee such as a nurse or physician assistant give the patient a direct 'no' on a physician's behalf. After a patient hears the no, the physician can come in and negotiate with the patient.
6. Convey empathy. Patients need to feel heard, so physicians should give patients their undivided attention and maintain eye contact. Empathy makes a world of difference and patients will be more prone to listen to a physician's reasoning if they connect with him/her.
7. Consider each patient individually. When a physician has to say 'no' to a patient, he/she should take the patient individually into account to gauge the best way to frame a response.
8. Place the blame elsewhere. Because the physician is often the only party in the room with the patient, a physician may consider deflecting the blame on a third party such as an insurance company or clinical guidelines.
9. Stand behind your decision. In a rare case, a patient simply will not take a 'no.' In these instances, it is crucial to be firm with the patient.
More articles on practice management:
Who is 'Dr. Robinson?' Teen poses as a physician, practices medicine without license
The ramifications of Justice Scalia's death: 5 health-related cases that may be affected
How copays affect medication adherence: 5 things to know