Navigation Links
Doctors Have Many Ways to Say 'No'
Date:2/22/2010

Consideration of patient's needs and beliefs helps preserve relationship, study finds

MONDAY, Feb. 22 (HealthDay News) -- When a patient asks for a treatment that a physician doesn't believe will work, savvy doctors say no very, very carefully.

Television advertising of prescription medicines leads many patients to request drugs that may be inappropriate for them. And new research finds that taking into account the patient's needs and desires is the most effective way for a physician to say "no," said Debora A. Paterniti, associate adjunct professor of internal medicine and sociology at the University of California, Davis, and lead author of a report in the Feb. 22 issue of the Archives of Internal Medicine.

She and her colleagues looked at 199 visits to primary-care doctors in which the patient requested an antidepressant -- the kind of request that doctors are familiar with because of direct advertising to consumers and word-of-mouth advice from friends and relatives, Paterniti said.

Eight-eight of those requests were denied, but in only five of those cases was the denial a simple "no."

Six approaches were used to explain why the prescription wouldn't be written. "Each of those strategies might reach different sorts of patients in different ways," Paterniti said.

In 53 cases, the doctors emphasized the patient's perspective. They asked where information about the drug came from and why they thought it might be helpful; recommended seeing a counselor or mental health specialist; or said something other than depression might be the source of the problem.

In 26 visits, the doctors took biomedical approaches, such as prescribing sleeping aids instead of antidepressants or ordering a diagnostic workup to detect problems such as thyroid disease or anemia.

"Physicians have a more nuanced strategy for dealing with patients than they did before," Paterniti said.

"Some physicians get stuck in their old ways," she said. "This offers physicians a variety of ways to talk to different patients and say no to requests that physicians might believe to be inappropriate to their care. Also, patients are much more satisfied with physicians who act in a way that pays attention to the situation that is driving the request."

It's not known if the antidepressant study can be generalized to other requests, "but at least our study presents a potential hypothesis to be considered," Paterniti said.

"Saying no is a fascinating issue, and what they highlight is exactly on target," said Dr. Charles E. Schwartz, an associate professor of psychiatry, family medicine and medicine at Albert Einstein College of Medicine and an attending physician at Montefiore Medical Center, whose duties include training new doctors in communication skills and working with patients.

"What we find in dealing with patients is that even if you disagree, you have to start where the other individual is starting," Schwartz said. "If you meet them where they are, you might be able to lead them somewhere else."

A request for an antidepressant must be handled with care, because it raises the delicate issue of possible mental illness, he said. But in any case, "people come in with ideas, thoughts and concerns about what is wrong with them and how to deal with them," Schwartz said. "Asking them what their belief system is, what they think is wrong -- those are the key questions to ask patients."

All the strategies described in the study were "patient-centered, or as I conceptualize it, starting where the patient is," Schwartz said. "All are extremely well thought-out, patient-friendly and strategic."

More information

A guide to antidepressants is offered by the U.S. National Library of Medicine.



SOURCES: Debora A. Paterniti, Ph.D, associate adjunct professor, internal medicine and sociology, University of California, Davis; Charles E. Schwartz, M.D., associate professor, psychiatry and behavioral sciences, family medicine, clinical medicine, Albert Einstein College of Medicine, and attending physician, Montefiore Medical Center, New York City; Feb. 22, 2010, Archives of Internal Medicine


'/>"/>
Copyright©2010 ScoutNews,LLC.
All rights reserved

Related medicine news :

1. UK junior doctors gaining less experience of common procedures
2. Doctors Often Miss High Blood Pressure in Kids
3. One-fourth of HIV patients believe their doctors stigmatize them
4. Annual flu shot cuts need for doctors visits, hospitalization among children
5. Teens need to see their doctors more often
6. Doctors and medical ethicist discuss whether doctors should participate in capital punishment
7. Doctors and Medical Ethicist Discuss Whether Doctors Should Participate in Capital Punishment
8. South Texas Doctors Report More Severe Cases of Community Staph Super Bug Hospitalizing Children
9. Maimonides Expands Circulation of Physicians Practice Journal to Staten Island Doctors
10. Doctors Debate Drugs vs. Surgery for Angina
11. UCI Medical Affiliates Inc. Opens a New Doctors Care Center in Anderson
Post Your Comments:
*Name:
*Comment:
*Email:
(Date:8/18/2017)... ... August 18, 2017 , ... With over 16,000 active patients, ... replacement therapy and integrative medicine, has become a frontrunner for people seeking help ... menopause, andropause, thyroid disorder and adrenal insufficiencies. , Founded in 2003 by ...
(Date:8/18/2017)... ... August 18, 2017 , ... Inc. magazine has ranked American ... prestigious ranking of the nation's fastest-growing private companies. This marks the eighth time in ... 5000 ranking . This year’s ranking reflects ASH’s 76 percent overall revenue growth from ...
(Date:8/18/2017)... ... ... “Dangerous Inheritance”: a mystery about saving the family farm. “Dangerous Inheritance” ... where she was raised on a farm. As Diane wrote this story, she ... friendships and mantra of ‘neighbors helping neighbors’ have always been a large part of ...
(Date:8/18/2017)... ... August 18, 2017 , ... “Depressed: Super Heroes of the ... to reflect upon the stories and the relevance these tales may have on the ... Jessica Linhart, a former special education teacher, Jessica spends much of her time enjoying ...
(Date:8/18/2017)... ... August 18, 2017 , ... “Prompted By Love”: a love story thrown into ... Mary Nettles. Author Mary P. Nettles has devoted her life to ministry since ... Her lifelong desire to write was, however, not fulfilled until 2014 when "The Color ...
Breaking Medicine News(10 mins):
(Date:8/7/2017)... Md. , Aug. 7, 2017 ... healthcare member acquisition, retention, and engagement, announced the ... of Strategy and Product Development, effective as of ... consulting and technology implementation strategy for our clients. ... of experience in consulting and business analytics within ...
(Date:8/7/2017)... , Aug. 7, 2017 Diplomat Pharmacy, Inc. (NYSE: ... Joel Saban as president, effective Aug. 7, 2017. ... has decided to pursue other interests and will serve as ... tenure, Paul has served us in multiple leadership roles since ... in Jun. 2015 and has provided decisive, strategic leadership which ...
(Date:8/7/2017)...  Endo International plc (NASDAQ: ENDP ) ... all known U.S. mesh product liability claims and that ... remaining U.S. claims at reasonable values. Under the agreements, ... quarter of 2017 and continuing through the fourth quarter ... results, the Company intends to increase its mesh product ...
Breaking Medicine Technology: