Take today’s poll: What kind of patient request makes you feel most uncomfortable?

M3 India Newsdesk Oct 15, 2019

Patients asking for things that doctors feel inappropriate about is commonplace. It is indeed in a doctor’s interest to safeguard his position and acquire this skill of handling such a situation. Answer the question below to find out if it is common with your peers. Read the article to know more on the subject.

What is considered to be inappropriate by doctors may be felt most appropriate by patients. So we need to be unbiased when considering patient requests as inappropriate. In other words, we need to get into the patient’s shoes to be fair and empathetic.

 

Read on to understand what solutions Dr. Amdekar has to offer in such situations.

It is a doctor’s duty to spend enough time with a patient, communicate and counsel properly and answer all questions however silly they may be. This should be the appropriate behaviour of a doctor. Only when we consider requests as inappropriate, we must respond and not argue. Response comes from the cerebral cortex while argument is only a knee jerk reaction from the spinal level. Response is a result of thought process that spells what is right while argument is meant to decide who is right in which case it becomes an ego issue.


Common requests from patients that are inappropriate

  1. Medical practice is the only profession where patients (clients) expect service at any time, based on the patient’s convenience, even in the absence of an emergency situation.
  2. Many times, advice is sought on the phone at odd hours and is expected to be delivered without seeing the patient, irrespective of the feasibility and is of course free of charge.
  3. Cellphones have made it possible to speak to the doctor directly at any time and the doctor is supposed to respond to each call, irrespective of being busy with another patient.
  4. Every patient expects to be attended in a short time even if he has come later than his scheduled appointment time. After all there are enough excuses to offer for being late.
  5. Majority of the patients have faith in medicines and tests so they insist to get them irrespective of whether they are required or not. Test results are believed more than doctor’s clinical judgment; that may be often questioned.
  6. Test results are sent on WhatsApp for interpretation, and instead of the patient or his relative bringing them to a doctor and detailed discussion is expected to be delivered over phone.
  7. At times, the patient expects a doctor to interpret results of tests ordered by another doctor or advice on medicines prescribed by another doctor. They expect a free second opinion without seeing the patient.
  8. Every concerned relative or friend of a patient expects latest information about the disease and progress on one to one basis and feels it is a doctor’s duty to satisfy their queries, as the patient is near and dear to them.
  9. Finally, the patient may expect concession in a doctor’s fees as no hospital, laboratories, or pharmacies offer any concessions.

How to respond to inappropriate requests

  1. Most important “mantra” is to not lose your temper but still make a point. For example, the patient arrives when you are about to leave the clinic, inform him that you are going to attend an emergency and so you would offer him first aid and ask him to report the next day.
  2. Don’t spend much time or discuss any details. It conveys to a patient clearly that he did not get full advice but at the same time you have attended to him and not sent him off without seeing him first. Wise patient learns not to repeat the same mistake.
  3. In the modern era of easy communication via cellphones, insist on messages and not calls on the cellphone. The cellphone must be used only for emergency situations. However, every patient claims an emergency and so the best way is to suggest urgent hospitalisation to be on the safe side.
  4. Encourage calls on the landline that can be attended by your assistants and answered accordingly. Assistant can be trained to reply to common queries. Automatically, calls on the landline will come during work hours. Remember, the Supreme Court expects doctors not to offer advice on phone without seeing the patient. Otherwise, the doctor is held responsible for the outcome. I have been giving advice over phone all these years but now I add to say this is first-aid advice and it is better that the patient is seen. So, you are legally safe and at the same time you can help patients.
  5. If patients insist on laboratory tests or x-rays, the best way is to say that in your opinion they are unlikely to help though the patient can get them done if they wish. It helps during those occasional times when such a test proves to be useful though with inconclusive reports, and the patient knows that he has spent money for nothing.
  6. If a patient asks for specific drugs like antibiotics that are not required, one must be firm not to prescribe. Many patients ask for tonics and I inform them that it would be harmless but useless, so they can decide. If they insist, prescribe it. After all manufacturer and chemist also must earn and everybody will be happy thereafter.
  7. If I am asked to opine on prescriptions or test results ordered by another doctor, I inform the patient that correct interpretation is possible only with correlation to physical examination. Most doctors don’t document their physical examination findings and so it is not fair for you to offer advice merely on test results.
  8. In serious situations, every close and not so close relative, or friend wishes to get first-hand information from the treating doctor. The best way is to request the immediate guardians to take care and if they wish, you should be ready to talk to all of them at one time.

Take-home message

Consider the patient request with due allowance to fear or concern of patients about the disease or treatment. So within limits, what is inappropriate to a doctor may be most appropriate to a patient. Inappropriate requests must be handled with care, calmness and in a diplomatic way to avoid bitterness and arguments. At the same time, show gentle firmness in your opinion. Remember, the patient has a right to his own views and so we should leave it to him to decide whether to follow your advice or not. So be flexible to a large extent especially when the patient’s views are harmless, though may also be useless.

 

Disclaimer- The views and opinions expressed in this article are those of the author's and do not necessarily reflect the official policy or position of M3 India.

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