How to say no to inappropriate patient requests

“Hey, doc, can you do me a favor?” This common question can quickly become one of the most challenging parts of your workday if it’s followed by an inappropriate request for opioids or benzodiazepines, work or school excuses, expensive tests or procedures, etc.

Saying no to these requests while preserving the patient relationship takes skill, but three tips can help.

1. View the patient in the best possible light. This is the antidote to further deterioration of a difficult patient interaction. The goal is to actively assume that the patient does not know that what he or she is requesting is inappropriate. This more neutral frame helps you respond to the patient more positively and more effectively. Viewing the patient negatively generally does not help the conversation.

2. Explicitly state that the patient's request is inappropriate. For example, it might be poor medical care, illegal, dishonest, or against policy. Couple this statement with a brief explanation but avoid lengthy explanations, which often create room for debate.

3. Reestablish rapport. Making empathic statements such as “I know this is not what you wanted” or “I can see you are frustrated” acknowledges the patient’s feelings. Another useful strategy is to use the phrase “I wish ... .” For example, “I wish oxycodone were safe to use for your pain. Unfortunately, it is not a safe treatment for your type of pain.”

Read the full FPM article: “Getting to No: How to Respond to Inappropriate Patient Requests.”