Health care is an ever-changing environment. Scientific discoveries and evidence-based medicine allow for disease diagnosis and treatment regimens to adjust to new guidelines quite often. Accompanying these changes are insurance companies, whether private or government, that alter policies and frequently dictate how health-care providers should administer care.
As if this were not frustrating enough, add to the equation the demanding patient who believes he or she is an expert in health and insists on telling you how to care for him or her. The most familiar scenario involves the patient who walks in and states, “This is my problem and I need you to prescribe me this.” Then there is the parent who is sure his or her child needs an antibiotic, and is not leaving until you prescribe one.
Granted, some patients are definitely an expert in their own health care, and rightfully should be. Patients often have an intuitive feeling that something is wrong, and many times a problem is indeed discovered. This also can be said for the parent who knows there is something wrong with his or her child and is later proven right.
Providers should not ignore these gut feelings from their patients. However, there are appropriate ways of saying “No” to a demanding patient.
Nonspecific or vague complaints of illness can be investigated by obtaining a detailed history and performing a thorough physical exam. The information yielded often helps the clinician establish the differential diagnosis and guides him or her toward noninvasive tests or treatments that can offer more insight.
For example, a patient might ask for a CT scan of the abdomen to assess a vague complaint of abdominal discomfort that has been occurring on and off for a few weeks with some nausea but no vomiting, diarrhea or fever. The cause could be Helicobacter pylori, a food allergy, constipation or an unexpected pregnancy.
Explain to the patient that a urine or blood test can easily confirm or rule out these conditions. This is one way to say no to the costly test the patient is requesting without being dismissive of his or her request for a particular diagnostic or therapeutic strategy.
There will always be the patient who knows what needs to be ordered and attempts to dictate how the clinician should practice, but providers can reassure these patients and gain their trust by communicating clearly and concisely the steps needed to best address the health-care issue at hand.
Trust in one’s health-care provider is the underlying issue here. Patients may no longer fully trust the clinician due to the abundant medical errors that occur every day. They may feel rushed during the office visit and feel that their complaints are not being heard.
These patients may then seek medical advice from friends, relatives or the Internet. This poses a problem due to the variable quality and accuracy of the answers they receive from those sources.
The health-care provider needs to gain the patient’s trust and simply find a way to work with the patient’s requests in a more respectful manner than just immediately and harshly saying, “No.” This, in turn, will reduce patient demands for services that take a higher toll than necessary on the patient, the provider and the insurer.
Saying “no” must be followed up with educating the patient as to why the answer is no and how a different approach to resolving the issue will benefit the patient.
Rachael Buitrago, DNP, CPNP, is an ANCC board-certified pediatric nurse practitioner in a private office in South Florida, and has taught as adjunct nursing faculty at local universities.