Inappropriate Demands From Doctors – How to Deal with it?
Dr Yeong Yeh LeeMD MRCP (UK) MMed
Lecturer/Physician
Department of Medicine July 2008
Outline
• Reasons why patients seek doctors?
• What doctors regard as inappropriate demands?
• How to manage the demands from public?
• How to handle demands from others including colleagues, bosses, family, friends etc?
• Case scenarios
Case Scenario 1
20 years old male with complaints of cough
and sore throat went to see a GP. Examination
was normal. The patient demanded 2 days off
from work and hope the GP can write him the
MC. The GP refused and he got scolded by the
patient.
Case Scenario 2
A 17 years old girl complaint of abdominal pain.
Later she confessed that she was pregnant and
she requested for abortion from the doctor. The
child was a victim of a failed relationship. The
doctor refused but suggested that she should
go elsewhere. The patient pleaded with the
doctor and finally the doctor agreed though its
against the law
Case Scenario 3
A doctor is a close friend with Mr H. Then Mr H
was diagnosed with terminal cancer and he
was suffering from intractable pain. The wife
of Mr H came to see the doctor and requested
the doctor to end his husband’s suffering once
and for all. She hoped the doctor can help his
close friend to die peacefully using medical
means
Case Scenario 4
There was a long queue of patients waiting to
see the doctor. However a government official
demanded that he should be seen by the doctor
first. The doctor could not refuse.
Source of Inappropriate Demands
• Profession related demands
- patients, colleagues, bosses
• Non-profession related demands
- family members, relatives, friends
Why do Patients look for Doctors?
• Symptom Iceberg• Role of demographic factors – Children,
elderly and Women consult more• Role of socioeconomic factors – Higher
social classes, unemployed and those stayed in rented houses seek doctors more
• Role of family – Wife the main role in family for doctor seeking
Why do Patients look for Doctors?
• Role of Psychological factors – perceived susceptibility, perceived severity, perceived benefits, belief in self-treatment (traditional methods, herbs, acupuncture etc), stressful life events
• Role of distance from hospital and role of appointment system – higher classes preferred private practice since is nearer and less waiting time
Copyright ©1998 BMJ Publishing Group Ltd.
Gillam, S. et al. BMJ 1998;316:1895-1898
How to manage increasing demands from the public?
• Health education – health promotion programmes, mass media, books, advice during consultation etc
• Triage through telephone helplines and computer generated algorithm
• Self-help information on internet
How to manage increasing demands from the public?
• Faster results from advanced diagnostic tests
• Tailor prescription practice according to patient’s expectations. Mismatch often leads to reconsult with other doctors
• Treat according to guidelines to reduce inappropriate care
• Referrals to secondary or tertiary care
How to manage inappropriate demands?
• Communication skills IMPORTANT- Explore reasons behind the demands- Challenge the demands- Know the laws and regulations- Explain the situation and make the patient
understand that demand is inappropriate- Offer solutions or help- If fails refer to someone more experienced
or higher authority
What about demands from colleagues or
bosses?
• Replacing or taking over colleague’s night duties/on-call
• Senior colleagues may pass his duties to a more junior colleague
• Demanding boss/HOD – on everything including fulfillment of admin duties, attendance of activities, job performance etc
• Demands from Hospital admin/Director
What about non-profession related demands?
• Family members may request special medical care from you
• No quality time with wife and children
• Friends may request for special favours
• BEYOND the scope of this lecture
• Seek appropriate HELP whenever needed
there will always be a better TOMORROW
And in the end, it’s not the years in your life that count. It’s the life in your years.- Abraham Lincoln