patient requesting specialized labwork
This is the original scenario submitted in the scenario selection phase. Click here to see the realistic script in development.
A patient comes into the office after visiting an alternative health provider. She has a list of specialized labwork and asks the physician to order it for her.
When the physician declines the request, being unclear about the rationale, value, etc. the patient becomes angry and demanding.
Category:
physician – patient
What's happening?
Feb 22 2012 (All day)
Nov 12 2011 - 9:30am
Comments
The arc of the story
The communication skills opportunity is for the physician to decline the patient's request without upsetting them.
Could focus the scenario by having the patient request labwork that should clearly (to the physician) should not be granted, while could seem perfectly reasonable to the patient. This takes away the possibility of give and take/negotiation about whether the lab work should be done, and keeps the arc on how to communicate that it is not an appropriate.
lab dilemma
I am seeing this more often, Pt sees a ND and in order to avoid testing cost, asked MD to order tests. Very often not indicated. This causes stress as MD is seen simply as a means to an end vs a trusted provider. How is this situation best managed without alienating pt?
I see a different opportunity here
I'm having a bit of a reaction to this comment, because I'd like the opportunity for empathic communication to be understood differently from what's described here.
I see that the opportunity is for the physician to demonstrate understanding of how the patient is feeling, and what need is addressed by the obtaining of the labwork. Once the physician demonstrates that, and the patient's (potentially unacknowledged) need to be understood is met, the physician can then have the opportunity to explain her own perspective - what's up for her. In response to this explanation, the patient may or may not feel upset; that's the patient's responsibility. What's important is that the physician understood what was behind the patient's request (i.e. heard it as a request, rather than a demand) and then honestly described what was up for her (the physician).
Although the words "reasonable" and "appropriate" will definitely appear in the physician's lines in the realistic scenario, they should probably be absent from the empathic translation. In the empathic translation, we're not making judgements (yes, I like to spell it with an "e") about what is reasonable and/or appropriate. Instead, we're noticing what it is that we feel and need in relation to things we observe.
Alternative Medicine
Our Web site has several modules on this...."I'm Going to Mexico" and a Freddie (International Health and Medical Media) Award winning (3 modules) called "Important Conversations: Complementary Therapies and Cancer" This award is considered the "Oscar" of the medical media world.