Successful Doctor-Patient Relationships

Physicians, at least most of us, are not businessmen.  Yet, we are negotiators.  When I was in private practice, for instance, we were running an actual business.  There were negotiations with our landlord, with insurance companies, with vendors and with new hires.   Now, as an employed physicians, all of these issues – and many others – are out of sight and out of mind.  But I am still negotiating.  With whom, you wonder? I negotiate with my patients.

I’m not suggesting that my doctor-patient relationships are cold, transactional events.  Hardly.  But every relationship, either business or personal, requires give and take.  Sometimes one party gives up some space to accommodate a compromise, and other times the partner behaves similarly.  Indeed, every successful relationship that I have participated in or witnessed is a breathing and flexible organism. 

Negotiating with patients is less formal than is depicted here.

Here is an actual example of a real ‘business meeting’ I had with a patient.

Mrs. S. is an elderly woman who lives alone.  One must scroll down through a few screens on the electronic records monitor to view her long list of illnesses.  It’s a similar experience reviewing her medication list.  She has a swallowing issue which is long standing and has been evaluated. She also has abdominal distress which probably dates back to the Truman Administration.  She calls insisting that I arrange a scope test (EGD) of her esophagus and stomach to crack the code of her unexplainable swallowing and digestive issues.  One of her other specialists casually encouraged her to contact me with the EGD request.  (As an aside, I have observed over the years that it may be easy for a physician to blithely recommend that a specialist colleague perform a test or even an operation when the referring doctor won’t be assuming any risk. I would have preferred that the doctor had advised the patient to see me for an opinion rather than suggest an EGD directly.)

A quick risk/benefit analysis did not support the EGD option.   Let me express my analysis in mathematical terms.

                                                       Risk>>benefit = Retreat!

I couldn’t talk her out of it.  She has been my patient for decades.  Although the medically and ethically pure answer was to decline any testing for her.  She shot down that trial balloon.  So I negotiated with her.

I know you’re worried about your esophagus even though I feel that all is well there.  I think the risk of the EGD and anesthesia exceeds the potential medical value. I worry that you could suffer an adverse outcome.  So, let’s arrange for you to undergo a much safer x-ray of the esophagus instead.  If this result is normal as expected, then you will be reassured.

Case closed.

The mark of a successful negotiation is when both parties step away from the table feeling good. 

Editor’s Note: For 16 years, I've published weekly essays here on Blogspot, which will continue. I’ve now begun publishing my work on a new blogging platform, Substack, and I hope you’ll join me there. Please enter your email address at this link to receive my posts directly to your inbox.