How to Say No to Unreasonable Patient Requests

As doctors, we have all heard unreasonable patient requests.

Some are so outrageous that legends are passed down the ranks. For the most part, we try to work as a team with our patients to reach the best treatment plans for them. Yet, a line must be drawn so we do not give in to nonsensical requests.

It is never easy to be the bad guy. But, we are not customer service representatives, rather professionals who possess an extensive training. If a mechanic told you that you did not need your brakes replaced, would you demand otherwise?

Saying no to unreasonable patient requests:

• Just say no Don't be vague. If you are not going to give in to something a patient is asking, say so. Don't let them believe you may change your mind. If a patient is requesting an opioid pain medication but you do not feel that is the best treatment for them, tell them you are not going to prescribe it. Don't give them "just a few" and tell them you are not comfortable prescribing it. They will be back and the same scenario will play out.

• Explain why you are saying no. To just refuse a request without explanation is rather cruel. For example, I sometimes will have patients ask me to send a prescription under another family member's name for insurance reasons. I explain to them doing this would actually be considered insurance fraud and we can both get into trouble for doing this. When most patients understand why, they completely understand and do not ask me again.

• Offer alternatives. In the above example, while I cannot write a prescription under another person's name, I can try to find cheaper generic medications that the patient may be able to use instead. For the patient in pain, instead of just saying no to a request for certain pain medications, I can refer them to a pain management specialist.

• Don't argue. We need to keep in mind that when patients see us they are often at their worst. We need to be empathetic and allow them some room to vent. We all know the healthcare system is not the easiest world to navigate these days. But if the patient becomes overly aggressive, we also need to know when to say enough, we are not discussing the matter further. Often, I see patients who want to argue over their bills. I do not engage in these discussions and immediately refer them to my biller. I explain that I rather focusing on their medical needs without financial distractions and they can work out the issue with the appropriate staff. Many patients simply ask not to pay what they are responsible for. It is hard for me to explain why I need to be paid (contractual obligations, overhead expenses, etc). These conversations never go well and avoiding them in the first place is the best solution.

• Be kind. A patient requesting an opioid medication may be in severe pain. They are often made to feel like drug dealers when they are seeking help for their medical problem. Even if we plan not to prescribe a certain medication, we need to be kind about it.

• Be consistent. If you one time you give in to one patient's request, such as to write off their copays, you will find others coming to ask the same thing. Patients talk to each other. When you write it off for one and not the other, people will get angry.

• Understand why a patient is making a request. A patient may come asking for a brain MRI for a trivial headache. While you think this test is unreasonable, the patient may be lying awake every night for weeks afraid that they have a brain tumor. When you understand why they are making a request, you can address the underlying reason. In the aforementioned example, you can explain why their symptoms do not suggest a tumor and they do not need the study. Just saying no does not serve this patient at all; they are still left with their fear.

• Set policies up front. It is much easier to tell a patient it is the policy of your practice, for example, not to prescribe certain medications. Make sure your staff is on board with these policies and everyone is telling the patient the same information.

As doctors, we must remain professional in the face of anything we may encounter in the exam room. It is our responsibility. And while we may think it completely unreasonable, we must remember that the patient may not.