When Patients Say No

How do you react when patients say “No, Doctor”. This is always a big question in medicine, getting patients to follow advice. In drug treatments it’s typically dosing compliance. In any other therapy where patients are typically treated intensively at first, it’s in-office and home care. But there is a bigger issue we need to be teaching our students early on.

Getting any human being to do anything they don’t fully understand or have faith in is futile.

This fact drives many people crazy. As Michael Gerber asserted first in the “E-Myth” many years ago, people are basically unmanageable. But what are manageable are results, systems and processes. They are also measurable. The good news is that just approaching your practice and indeed your life like this frees up enormous amounts of emotional energy.

Still, though, we are dealing with people, not hardware.

There is one thing that almost every human being responds to in kind, and that is stress free relationships with other humans, based upon trust. And of course in medicine, trust means expertise, experience and reassurance.

It’s in simply recognizing and fixing this in any healthcare scenario that builds huge patient bonds, and so often markedly better results and compliance.

So, how do we continuously build trust?

By making frequent connections on a basic, human level.

Be a better physician by using multiple avenues. Phone calls, supportive group “visits”, newsletters, handouts, Christmas Cards and more.

This is also why effective and professional usage of social media can be reassuring and soothing when patients need it the most.

And you know what?

This approach always works no matter what the size of your practice, hospital or group.

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  12 comments for “When Patients Say No

  1. a gndin
    February 26, 2020 at 8:24 pm

    Exactly! Her family was pressuring her.

  2. arf
    February 24, 2020 at 6:01 pm

    I wish they would say no t SOMA more often.

  3. arthur gindin
    February 23, 2020 at 1:02 pm

    I can only sympathize with the GP’s who have chosen Family Practice.

  4. Art Gindin
    February 22, 2020 at 11:19 pm

    I once had an elderly lady. She had specific complaints and I described a procedure that might be helpful: a decompressive laminectomy, She refused to have the procedure. She brought with her about SIX family members. I explained to ALL that I would not do the procedure AGAINST her will. They were convinced that she would complain less after the procedure. They brought her back again and she refused again. I never saw her again.

    • Kay Victor Adamczak
      February 23, 2020 at 8:26 am

      Sounds as if the family may have been pressuring her. She may have been reacting to the family trying to browbeat her and not you.

      • arthur gindin
        February 23, 2020 at 12:58 pm


        • R Stuart
          February 23, 2020 at 3:58 pm

          Did you send her a Christmas card?

      • John Hayes Jr
        February 25, 2020 at 1:56 pm

        Exactly Kay.

  5. Kay Victor Adamczak
    February 22, 2020 at 1:32 pm

    I frequently say no to my physician.
    I told her early on that I will listen to any recommendations she makes as long as she understands that I and I alone, make the decisions.
    I will be candid, I’ve told that to others who have essentially told me that I must do as they say or I will be discharged. I told them goodbye! I’ve also been discharge several years after the fact for saying and having the PCP agree that I make the decisions.. I was told it was because they couldn’t establish a “therapeutic relationship” with me. I hold the opinion it was because my annual poke and grope visit your renew 1 medication wasn’t making money for the practice.
    I refuse most USPSTF recommendations and make no apology or justification for doing so. It is my body and my decision. Refusals are documented in the chart.

    • Jennifer Hollywood
      February 23, 2020 at 11:05 am

      While I agree. Your body and your choice. In the current PCMH environment your physician can have his income reduced if you refuse to do certain metrics. Compensation is tied to meeting metrics. If you opt out of the metric then that lowers your physicians score and as a result his income. This all started with HEDIS. Then CMS quality measures and MIPS. And Obamacare. Insurance is taking away your choice. And your physician doesn’t want to get penalized by the insurance company. They actually harass us to get patients to complete certain tests. They come around with lists that we have to complete or they lower our pay. It’s not so much about that one visit not being lucrative enough. It’s about not completing all the check boxes the insurance company demands which can lead to a reduced income for ALL his visits for all patients.

      • John Hayes Jr
        February 25, 2020 at 1:57 pm

        Jennifer this whole issue, though well known is reprehensible.

        • Jennifer Hollywood
          February 25, 2020 at 3:03 pm

          Agreed. But somewhere along the way the government and insurers hijacked health care for their own benefits. Now we all suffer. Patients and physicians alike.

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