Doctors and nurses aren't human...or so they think

OMG, Laura - this was just going through my head. I tell a pt he needs to call ahead before bringing in stuff for a pt assistance program so he makes sure I'm there as we need to also have him sign forms. He shows up unannounced and is irritated because he either has to wait or come back because I'm out at lunch. Sorry - I eat. I'm human.

I'm human and I get sick, too (rarely, but it happens.) If a patient has waited until the last possible second to request something that only I can provide, and is stymied by the fact that all the stars weren't in alignment and his poor planning has now caused him problems, this is not my issue.

Thankfully, I am excellent at limit setting lol. I get the sorts of patients you referred to in your original post, and they get the broken record technique of "no" on unreasonable requests until either they FINALLY understand or they do something rude/abusive enough to allow me to have them ejected.

Good for your practice for refusing to allow this kind of nonsense :).

Wasn't it a beautiful day? :) Hope you enjoyed the weather and even the lawn mowing!

Limit setting examples - hmmmmm.

OK - pt calls: "I have a cold and I need atbx; I need the doctor to call me in a prescription."

Me: "Our policy is that we don't prescribe atbx sight unseen. I would be happy to set an appt for you so the doctor can evaluate you and see whether atbx are indicated in your case."

Them: "But this happens to me all the time. I know I need atbx. My doctor at home always just calls me in a z-pak."

Me: "That may be, however, our policy here, because of the risks of antibiotic resistance, is that people must be evaluated in person."

Them: "Well that's just ridiculous. I can't believe I have to be seen to get antibiotics when I obviously need them."

Me: "Can I make you an appointment?"

(Them - 9/10 times, yes. I do also advise them that the fact that they are being seen does not guarantee getting the particular medication they think they need and that their treatment will depend on what the doctor sees on evaluation. Always important to look for any obvious major misconceptions the pt may have and correct them to avoid conflict later.)

The biggest trick is stating (1) your request cannot be fulfilled as is (2) offering what you CAN do (3) reiterating again (usually necessary at least once) that the alternatives offered are the only alternatives (4) determining which of the possible alternatives the patient wants to avail himself of, and (5) where possible doing a little patient education on policy stuff so that similar confusion can be eliminated in the future.

I don't know that, for instance, you have patients that come into your office the day after they took their last dose of a scheduled med, expecting to get a refill authorized immediately? We do - the joys of working with a patient population that doesn't really uderstand how the health care system works. I have a strict policy that their lack of preparation does not become my emergency. I take it as an opportunity to educate the patient on how things work, and chart said education so if they show up unannounced again (and they rarely do since I don't reward it) then we can be a little stricter still.

I had one pt who clearly had a personality disorder who would repeatedly show up late (1/2 - 2 hours late) for appointments and still expected to be seen. He would attempt to argue with and bulldoze over whoever he got to first. I have a special policy with this type of patient that only I am to deal with them, whether it be on the phone or in person. If that pt calls and I am not available, the staff takes a message and I call the person back - the other staff do not attempt to do any problem solving for that pt as consistency of approach is so vital it can only be achieved by having the same person dealing with him every single time so you know exactly what the patient has been told (no rule bending whatsoever for this guy.) If he shows up for an appointment, late or on time, I deal with him. If I am going to be out for any reason, there is another person designated as the go-to guy. Some people you just can't leave to chance. We don't really have the option to fire people unless there are extrememly extenuating circumstances, unfortunately, but I can make sure that I minimize the havoc he wreaks by limiting the number of people he comes into contact with.

Forgot to add: actually had one pt making an unreasonable request respond to my limit setting with "Well, I'm not going to accept that as an answer." My response, "Reality can be difficult to accept, but that is the ways things are. Is there anything else I can do for you?" Sometimes people require a closing line that leaves no room for argument. I'll occasionally get, "I want to speak with the doctor about this." My response, "The doctor does not argue policy questions. If you have specific policy concerns you can speak with (administration/office manager.)" This is rarely employed and it's still rarer to have someone take me up on it, and when they have, the powers that be have backed me because I am following the policies they established.

I understand the "warm but professional" goal, Darla - ideal in my line also. I work with college students in a student health clinic. I come across a little less hard line with the same words lol, which is a hard feel to impart on a BB. Everything is with a smile :). But I do feel very strongly that I need to educate these first-time adults on how to properly navigate the health care system. That includes having them check with their insurance companies for preferred providers when a specialist referral is warranted - stuff like that.

I get the "when are antibiotics going to go over the counter" question a lot lol. I usually say something along the lines of "when people can differentiate among bacterial infections, viral infections, and allergies at home." Right now they do a pretty bad job of it .

The biggest challenge is dealing with the parents. (1) I can't talk to them without the students permission (even tho in every case where parents are calling, I'm sure the parents are paying the bills and (2) the parents want to tell you what the students' pediatrician/uncle-who's-a-physician/sister-who-is-a-secretary-for-a-dentist thinks the student should be treated with .