Inappropriate demands from doctors

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It is common for doctors to cope with demands from public, its own professional circle, family members and friends. Many of these demands are often inappropriate. How does one cope with it when such situation arises?

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Inappropriate demands from doctors

  1. 1. Inappropriate Demands From Doctors – How to Deal with it? Dr Yeong Yeh Lee MD MRCP (UK) MMed Lecturer/Physician Department of Medicine July 2008
  2. 2. Outline <ul><li>Reasons why patients seek doctors? </li></ul><ul><li>What doctors regard as inappropriate demands? </li></ul><ul><li>How to manage the demands from public? </li></ul><ul><li>How to handle demands from others including colleagues, bosses, family, friends etc? </li></ul><ul><li>Case scenarios </li></ul>
  3. 3. Case Scenario 1 <ul><li>20 years old male with complaints of cough </li></ul><ul><li>and sore throat went to see a GP. Examination </li></ul><ul><li>was normal. The patient demanded 2 days off </li></ul><ul><li>from work and hope the GP can write him the </li></ul><ul><li>MC. The GP refused and he got scolded by the </li></ul><ul><li>patient. </li></ul>
  4. 4. Case Scenario 2 <ul><li>A 17 years old girl complaint of abdominal pain. </li></ul><ul><li>Later she confessed that she was pregnant and </li></ul><ul><li>she requested for abortion from the doctor. The </li></ul><ul><li>child was a victim of a failed relationship. The </li></ul><ul><li>doctor refused but suggested that she should </li></ul><ul><li>go elsewhere. The patient pleaded with the </li></ul><ul><li>doctor and finally the doctor agreed though its </li></ul><ul><li>against the law </li></ul>
  5. 5. Case Scenario 3 <ul><li>A doctor is a close friend with Mr H. Then Mr H </li></ul><ul><li>was diagnosed with terminal cancer and he </li></ul><ul><li>was suffering from intractable pain. The wife </li></ul><ul><li>of Mr H came to see the doctor and requested </li></ul><ul><li>the doctor to end his husband’s suffering once </li></ul><ul><li>and for all. She hoped the doctor can help his </li></ul><ul><li>close friend to die peacefully using medical </li></ul><ul><li>means </li></ul>
  6. 6. Case Scenario 4 <ul><li>There was a long queue of patients waiting to </li></ul><ul><li>see the doctor. However a government official </li></ul><ul><li>demanded that he should be seen by the doctor </li></ul><ul><li>first. The doctor could not refuse. </li></ul>
  7. 7. Source of Inappropriate Demands <ul><li>Profession related demands </li></ul><ul><li>patients, colleagues, bosses </li></ul><ul><li>Non-profession related demands </li></ul><ul><li>family members, relatives, friends </li></ul>
  8. 8. Why do Patients look for Doctors? <ul><li>Symptom Iceberg </li></ul><ul><li>Role of demographic factors – Children, elderly and Women consult more </li></ul><ul><li>Role of socioeconomic factors – Higher social classes, unemployed and those stayed in rented houses seek doctors more </li></ul><ul><li>Role of family – Wife the main role in family for doctor seeking </li></ul>
  9. 9. Why do Patients look for Doctors? <ul><li>Role of Psychological factors – perceived susceptibility, perceived severity, perceived benefits, belief in self-treatment (traditional methods, herbs, acupuncture etc), stressful life events </li></ul><ul><li>Role of distance from hospital and role of appointment system – higher classes preferred private practice since is nearer and less waiting time </li></ul>
  10. 13. Copyright ©1998 BMJ Publishing Group Ltd. Gillam, S. et al. BMJ 1998;316:1895-1898
  11. 14. How to manage increasing demands from the public? <ul><li>Health education – health promotion programmes, mass media, books, advice during consultation etc </li></ul><ul><li>Triage through telephone helplines and computer generated algorithm </li></ul><ul><li>Self-help information on internet </li></ul>
  12. 15. How to manage increasing demands from the public? <ul><li>Faster results from advanced diagnostic tests </li></ul><ul><li>Tailor prescription practice according to patient’s expectations. Mismatch often leads to reconsult with other doctors </li></ul><ul><li>Treat according to guidelines to reduce inappropriate care </li></ul><ul><li>Referrals to secondary or tertiary care </li></ul>
  13. 16. How to manage inappropriate demands? <ul><li>Communication skills IMPORTANT </li></ul><ul><li>Explore reasons behind the demands </li></ul><ul><li>Challenge the demands </li></ul><ul><li>Know the laws and regulations </li></ul><ul><li>Explain the situation and make the patient understand that demand is inappropriate </li></ul><ul><li>Offer solutions or help </li></ul><ul><li>If fails refer to someone more experienced or higher authority </li></ul>
  14. 17. What about demands from colleagues or bosses? <ul><li>Replacing or taking over colleague’s night duties/on-call </li></ul><ul><li>Senior colleagues may pass his duties to a more junior colleague </li></ul><ul><li>Demanding boss/HOD – on everything including fulfillment of admin duties, attendance of activities, job performance etc </li></ul><ul><li>Demands from Hospital admin/Director </li></ul>
  15. 18. What about non-profession related demands? <ul><li>Family members may request special medical care from you </li></ul><ul><li>No quality time with wife and children </li></ul><ul><li>Friends may request for special favours </li></ul><ul><li>BEYOND the scope of this lecture </li></ul><ul><li>Seek appropriate HELP whenever needed </li></ul>
  16. 19. 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

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