How to respond to inappropriate patient requests

When patients ask, “Hey, doc, can you do me a favor?” and that favor is an inappropriate request for opioids, work excuses, expensive tests, etc., this five-step “FAVER” approach can help you respond effectively while preserving the patient relationship.

F: Recognize any uncomfortable feelings that stem from the patient’s request. These feelings are the cue that you may need to think carefully about the situation.

A: Analyze why the patient’s request makes you feel uncomfortable. Your discomfort can usually be mapped to one of the following reasons – fulfilling the request would be poor medical care, illegal, dishonest, or against policy.

V: View the patient in the best possible light. If you assume the patient knows that his or her request is “wrong,” this can compound negative feelings and complicate the interpersonal interaction further, so begin the discussion with good intent.

E: Explicitly state why the request is inappropriate. For example, state that it would be poor medical care, illegal, dishonest, or against policy. Be careful to avoid lengthy explanations, which invite debate.

R: Reestablish rapport. Try using empathic but decisive language such as “I know this is not what you wanted” or “I wish I could write you an excuse. It would not be honest, though, so I can’t.”

Adapted from “Getting to No: How to Respond to Inappropriate Patient Requests.”