The Customer is Not Always Right: Why Healthcare is Different
Have you ever felt pressured to prescribe a medication because a patient wanted it, yet you knew it wasn’t the right decision? Have you ever given in to a patient’s request just because you didn’t want to deal with an unhappy or difficult patient or you were afraid of the scathing online review? Come on…if you’re saying, “No,” then I don’t believe you. Because I have done it too.
So let’s talk about some scenarios…
A patient that insists on getting prednisone for chronic hives because it’s the only thing that works but hasn’t even tried antihistamine therapy yet. Or how about an acne patient that wants to continue with antibiotics after 3-4 months of therapy, while being nonadherent with topicals, and pressures you to refill the script? Perhaps the most frustrating is when you give a diagnosis and treatment, your patient doesn’t agree or isn’t willing to try any of the treatment options you’ve offered. But they do believe their best friend Lisa, who’s skin expertise is limited to reading Reddit and following TikTok trends.
Sounds outrageous? No, that is the world we live in now. We’ve all been there.
The growing pressure to please patients today is real with direct-to-consumer marketing of pharmaceuticals, social media influencers and medical misinformation. Patients are more engaged in their care, often researching their diagnosis and treatments before even stepping foot in our offices. Thank you, Dr. Google. Providers worry about online reviews and patient satisfaction surveys. Some employers might even tie compensation to those satisfaction metrics, which is a potential motivator to give in to patient demands, even if there is evidence and logic pointing to the contrary.
Back when I worked at an academic institution, I remember being honored with an award for patient satisfaction in the top 10% of the country. But was that satisfaction driven by my dazzling personality or professional skills as a dermatologist? I was hoping maybe for a little of both. But it’s an important realization that just because a patient isn’t satisfied, it doesn’t automatically equate to inadequate care. Maybe the patient didn’t get their way, or the provider was rude. However, data does show that patient satisfaction impacts clinical outcomes, patient retention and medical malpractice claims.
A key take away is that no can be an act of caring and our conversation with patients should center around evidence-based medicine and a focus on long term patient safety. We take an oath to “Do no harm,” and we also bear responsibility for the stewardship of healthcare resources and not contributing to problems like antibiotic resistance. The goal should be to build trust through honest conversations and sometimes that will put us at risk for the bad review or poor survey scores. However, we cannot be bullied into prescribing, ordering tests or performing procedures if we do not believe it is in the best interest of the patient.
Communication is the real prescription. What’s essential is to validate our patient’s concerns and understand their point of view. Make them partners in their care and listen. If you disagree, then explain why. Leave behind the attitude that “I’m the doctor, that’s why.” That mantra doesn’t work like it once did. Just being a doctor or a health care provider isn’t enough–You need to offer a rationale or explanation. Don’t think of that as insulting or problematic, but rather an opportunity to explain your reasoning behind your diagnosis and treatment plan to get everyone on the same page. Sometimes the most important prescription we provide is the confidence to say, “This isn’t the best choice for you—and here’s why.”
Trotter’s Take: Patient centered care does not mean giving everything they ask for. It means partnering with them to make the best decision—even when that decision isn’t the one they expected.
Want to hear more about navigating challenging patient conversations and the art of evidence-based prescribing? Then tune into my latest podcast with Dr. Jim Del Rosso as he gives it to you straight.
