What Can the Doctor Do?
So how can a physician navigate the shoals of patient demand and responsible use of medical resources?
"The biggest mistake physicians make is simply saying 'no,'" says Dr. Brody. "When I was in practice, I'd often begin by saying, 'If after we're finished speaking you still want that test, I'll order it for you. Having said that, please hear me out about why I don't think it's a good idea.'"
By making it clear from the outset that he respected their prerogative and wasn't trying to deny them anything, Dr. Brody says he was able to gain patients' attention. Rather than devising arguments about why they should have the test, patients listened as he described his reasons for not wanting to order it. Having listened, they often agreed with his thinking and changed their minds.
"The second biggest mistake physicians make is not finding out the specific underlying reason that the patient is requesting a test," says Dr. Monica Broome, director of the Communication Skills Program at the University of Miami Miller School of Medicine. Although patients shouldn't be asked "why" they want a test because it forces them to defend and justify their request, Dr. Broome says probing their rationale and listening to understand can help a doctor address and allay concerns in a meaningful way.
"By saying, 'I understand your knee is hurting you. What specifically are you concerned about?' Or 'What do you think the MRI will show?' I can better understand their concerns and go through the signs and symptoms of a particular condition and explain why it's probably not the cause of their complaint."
Although these conversations certainly take time, Dr. Broome insists a few minutes will do the trick. What's more, she says, they frontload the patient visit and prevent the protracted "doorknob question," at the end of the encounter.
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Cite this: 'I Can't Give You That Test': How to Tell Patients - Medscape - Jun 26, 2013.