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