TY  - CHAP
M1  - Book, Section
TI  - Negotiating Requests for Tests, Referrals, and Treatments
A1  - Kravitz, Richard L.
A1  - Street, Richard L.
Y1  - 2021
N1  - 
T2  - Understanding Clinical Negotiation
AB  - Clinical  Take-AwaysThe  clinical  encounter  affords  patients  and  clinicians  the  opportunity  to  influence  each  other—patients  by  what  they  reveal  and  request,  clinicians  by  what  they  ask  and  recommend.During  a  typical  outpatient  encounter,  patients  make  requests  for  both  information  (e.g.,  about  the  significance  of  a  symptom  or  lab  result)  and  action  (e.g.,  for  medications,  diagnostic  tests,  or  referrals).Patients  whose  requests  for  services  are  denied  tend  to  be  less  satisfied  with  their  care,  less  likely  to  recommend  the  clinician  to  a  friend,  and  (for  acute  conditions)  less  likely  to  report  symptom  resolution  at  follow-up.Clinicians  are  not  obliged  to  accede  to  requests  that  are  unreasonable,  convey  greater  expected  harms  than  benefits,  or  violate  their  own  sense  of  professionalism.  However,  summarily  rejecting  a  patient’s  request  will  reliably  diminish  the  patient’s  care  experience.Clinicians  should:Give  the  patient  an  opportunity  to  lay  out  their  full  agenda  at  the  beginning  of  the  visit.Talk  less  and  listen  more—try  to  pick  up  on  why  the  patient  is  requesting  a  potentially  inappropriate  service.Focus  less  on  what  patients  ask  for  and  more  on  why  they  are  asking.Be  alert  to  patient  cues  and  respond  to  patients’  emotions.Be  aware  of  their  own  emotional  responses  to  patient  requests.When  faced  with  a  request  for  low-value  care,  consider  substituting  another  service,  stalling  for  time  by  offering  a  contingency  plan,  and  providing  clear  instructions  for  reconnecting  should  the  patient’s  clinical  condition  fail  to  improve.  
SN  - 
PB  - McGraw Hill
CY  - New York, NY
Y2  - 2024/04/23
UR  - accessmedicine.mhmedical.com/content.aspx?aid=1181983459
ER  -