Can a Good Doctor Just Say No?

Disclosures

August 29, 2014

Physicians are under increasing pressure to lower healthcare costs, conduct fewer tests, and prescribe fewer drugs.

Many physicians have complained that while they are being "encouraged" -- either through carrot-or-stick tactics -- to perform fewer services, the ratings and reviews that patients may give them continue to work against doctors' efforts.

Some patients who don't get what they want will retaliate online. Others whom you've seen in a hospital or large health system may give negative or harsh responses on patient satisfaction surveys. And a number may not say anything publicly but will "vote with their feet" and look for another doctor.

Understandably, doctors feel pressure to give in to relentless patients, knowing that the consequences of saying no can have long-term effects on one's practice and career. In a recent Medscape report on antibiotics use, 28% of physicians said they prescribed an antibiotic because the patient asked for it, and 15% said they did so out of malpractice concerns.

Some doctors take the additional time to explain the science behind why a certain test or drug isn't necessary, and many patients will then feel that they've learned something and will understand the doctor's guidance. But other patients feel like they are fighting for their life or health and surely don't care about society's healthcare costs in that case. Doctors have stated that trying to explain the logic behind pharmacology to someone who has had one year of high school science that includes botany, weather, geology, and astronomy won't get you far.

As Dr. William Sonnenberg, MD, president of the Pennsylvania Academy of Family Physicians, noted, "We should try to be kind to our patients and take time to understand them, but we must resist these misguided pressures and do the right thing. Sometimes patients have to be told 'no,' and the leadership in healthcare must understand this. Take heart in the words of Mark Twain: 'Always do what is right. It will gratify half of mankind and astound the other.'"

Often the difficult path is the right one. But there's more to the equation. Doctors should not be penalized for practicing medicine the way they feel is most beneficial. Should there be more consumer education (eg, brochures in the waiting room) to explain the difference between bacterial and viral illnesses? More science education in schools? More ways to combat online ratings? Less focus by insurers and healthcare leaders on patient satisfaction scores?

It's not right for someone to feel that almost every direction they turn in will lead to a detrimental consequence. There may be an answer to the "make the patient happy at all costs" dilemma, but we haven't found it yet. If you have thoughts on the issue, we'd love to hear them.

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