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Sometimes, what the patient wants isn't what the patient needs.
DANIEL J. FRASCA, DO
“Thanks for nothing!” my patient said as he stormed out of my exam room. He was an otherwise healthy 22-year-old with a three-day history of sore throat, cough, and congestion, but no fever. He was eating and drinking well, and the review of systems was otherwise negative. His vital signs were within normal limits, with an unimpressive exam overall. Despite my low clinical suspicion for streptococcal pharyngitis, per our local protocol, I did offer to do a rapid strep test and throat culture.
“No, that makes me gag,” he said.
We went back and forth, and I did my best to appease him. When I refused to give him antibiotics for his self-diagnosed strep throat, offering a myriad of supportive medications instead, he left in a huff.
These occurrences are common in family medicine, whether they involve a patient demanding antibiotics or other drugs, or complaining about wait times or insurance rules. The root issue is a discrepancy between the patient's expectations and what we as physicians can reasonably do.
How do we reconcile these issues to minimize negative encounters?
1. Seek to understand the true goal of the patient. When we don't see eye to eye with a patient, our first step should be to try to understand his or her goal. It may be as simple as relief from the symptom bothering the patient the most (sore throat in the earlier example), or it may be connected to a deeper issue — a need for assurance, a desire to be heard, or worries about end-of-life comfort. Active listening and validation of concerns are key.
2. Protect continuity of care. This helps us build rapport and a trusting relationship with the patient over time. It also helps foster an understanding of the social background and underlying concerns, which may be difficult for the patient to articulate. We can then offer to discuss the issues and counsel the patient as indicated.
3. Remember that what is best for the patient may not be what the patient wants. Sometimes, in the best interest of
Dr. Frasca is core faculty and an assistant professor in the Family Medicine Residency, Dwight D. Eisenhower Army Medical Center, Fort Gordon, Ga.
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Home / Journals / fpm / Vol. 28/No. 6(November/December, 2021) / The Last Word: How to Respond to Unreasonable Patient Expectations