- Requesting off-hours or off-location appointments;
- Delaying post-surgical follow-up appointments;
- Requesting variances from standard care (for example, requesting physical therapy when inappropriate); and
- Asking for additional medications that aren’t warranted (although both have noted that they have never had a problem with medication exceptions for physician-patients).
“I think it’s really important, whether we are the patient or the physician, to understand that bending the rules can cause imperfect outcomes,” Dr. Chandrasekhar said. “You have to be kind and gentle, and when they ask for an exception, you have to say no.”
Explore This Issue
July 2020Lay patients can become anxious about symptoms and treatment when they rely on “Dr. Google” for researching information. While physician-patients aren’t likely to do their research through search engines, they can also develop anxiety when they research treatments on their own.
“I have found myself in all-out negotiations with a physician-patient,” Dr. Chandrasekhar said. “I have had to dig in my heels. One patient, a psychiatrist who really understands drug metabolism more than most people, had really in-depth questions. I listened to her and explained the best I could, but I eventually had to tell her to stop. Her ‘academic’ discussion was distracting from the care she needed.”
Dr. Simpson agreed, explaining that open lines of communication are important. He often gives physician-patients 24/7 access via phone or text but said he has never had a problem with someone abusing direct access.
Questioning a medical opinion is less common but not unheard of. “A physician-patient once argued with my interpretation of the videostroboscopy exam findings,” Dr. Simpson recalled. “I was 20 years into my practice, and he said I didn’t know what I was talking about. He was being combative and aggressive—I didn’t see that coming. I was respectful to him, but ultimately referred him to someone else.”
No patient likes to hear the word “cancer,” Dr. Khariwala said, and physician-patients are no exception. “It’s more sobering for them,” he said. “They know the potential outcomes can be very bad. The challenge is to not let their knowledge and experience, and what they’ve seen this disease do, impact their outlook and attitude,” he said. “You have to make sure they know that many patients do very well. I emphasize the upside, the cure rates, the likelihood of success.”
One of Dr. Khariwala’s physician-patients with a small tongue cancer was disappointed when a lymph node test was positive upon completion of the surgery, resulting in the need for adjuvant radiation.
“She thought she would get the surgery and be done,” he said. “She started worrying about end of life. It was very hard for her because her initial impression was that it was an early tongue cancer, which it was, but it kept morphing into more and more treatments. It became overwhelming at some point. I’m delighted to report she’s doing well now, but it wasn’t easy.”