A patient recently came to visit Jeanne Hatcher, MD, associate professor of otolaryngology–head and neck surgery at Emory University in Atlanta, for a laryngeal dilation for stenosis. It was not an unusual request, except for this: The patient had already been in to see Dr. Hatcher before, when she performed the procedure. And then the patient had gone to another ENT surgeon.
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March 2025Now, the patient was back, asking Dr. Hatcher for another rendition of the same procedure, and she had been wanting narcotics after each one. From a medical necessity standpoint, the patient did not need the procedure for breathing; she already had a trach.
This time, Dr. Hatcher refused. The patient insisted, saying, “I think it helps.”
“I said, ‘Well, I understand that, but no,’” Dr. Hatcher recalled.
The patient’s relief after the surgery may have been real, Dr. Hatcher reasoned, but it was transient. So, she began to wonder, “What are we really doing?”
Even when physicians and others are on the same page, practicing otolaryngology can be difficult; diagnosis might be a challenge, and there is always the potential for surprises or complications. But in some cases, direct conflicts can arise—between physicians and patients, between physicians and other members of the care team, between physicians and administration, and even between objective test data and patients’ subjective reports. These situations can present some of the trickiest terrain in otolaryngology and other medical disciplines.
Otolaryngologists say that carefully choosing the right words, understanding the goals and values of the other party involved, and having a good dose of self-awareness go a long way, both in helping to avoid these conflicts and in preventing their escalation when they arise. They also say that, although there are some general guideposts to bear in mind, this is not an area typically covered much in training and that a feel for it develops with experience.
Dr. Hatcher, who is also the co-chair of Emory’s Patient Advocacy Reporting System (PARS) and the physician’s working group in Emory’s Office of Well-Being, said that over the years, she has found that being forthright is usually effective.
“I am fairly blunt,” she said. “And I think most people, based on reviews and what they tell me, is they appreciate that, that there’s no beating around the bush or sugar coating.”
But she has found a few effective strategies that she turns to when needed, she said. If she senses she is at odds with a patient and is aware that she might be fatigued, she might take a quick break, letting the patient know she is going to check their chart “to make sure I’m not missing something.”
I am fairly blunt. And I think most people, based on reviews and what they tell me, is they appreciate that, that there’s no beating around the bush or sugar coating. — Jeanne Hatcher, MD
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