When Patients Push Back: Choosing Curiosity Over Assumption

“Dr. Leung, the patient insists on seeing you and not the nurse practitioner today,” my nurse informed me.

Let us call her Ann. Ann is a young patient I met recently in the hospital with low platelets. Michelle, my nurse practitioner, saw Ann in one of the follow-up visits and sent her to the hospital because she appeared ill.

My schedule was overbooked that day. Although I met Ann not too long ago, she gave me the impression that she was someone easy to talk to, someone who was compliant and someone who would follow instructions. I was taken back by Ann’s demand.

I could have chosen to focus on the fact that Ann was put on Michelle’s schedule because my schedule was already full. Adding her back to my schedule was more than I planned. Or I could have chosen to see Ann and make it work. I chose the latter. When a patient is opposed to seeing a clinician, for whatever reason, it is not going to be helpful to keep that encounter.

The initial thought I had was why Ann was being difficult. Then I decided to be curious to find out why she refused to see Michelle. Instead of feeling upset, I was calm walking into the exam room. I asked her why she did not want to see Michelle – in a non-judgmental way.

It turned out that Ann believed she ended up in the hospital last time because Michelle changed her medication. It made sense. Ann thought that Michelle did something wrong and that was why she ended up in the hospital. So I explained that she was sent to the hospital for another reason, and that it had nothing to do with her medication being adjusted. I also assured Ann that Michelle and I work as a team, and we always make sure we are on the same page. Ann was satisfied with my explanation. She appeared relieved.

Imagine if I did not choose to see Ann that day. Ann could become upset. Although it was a misunderstanding, she lost trust in the nurse practitioner because she believed Michelle did something wrong. Why would she want that clinician to take care of her again? Of course she would not. By choosing to see her despite my busy schedule, misunderstanding was resolved. She trusted me and I allowed her to see beyond her own understanding to uncover the reality. Yes, it was some extra time for me. At the same time, we restored her trust and she would be comfortable to see Michelle again.

It pays off to be curious and explore. When other people recount an incident, it is easy for some personal opinion to be added while they believe that they are giving you the truth. It is important to distinguish between facts and fiction. What is an objective encounter and what is an opinion? When you realize that someone else is giving you their opinion, it is time for you to separate the facts and their thoughts. You can then be curious about the why – why is the patient acting that way? Why is the nurse thinking that way?

Observe without judgment until you get to the bottom of the situation. Sometimes all it takes is to ask the person directly. When you get your information second or even third hand, there is an increased chance of misinformation and misunderstanding.

I am glad that I chose to understand Ann’s situation rather than making conclusions prematurely. Being curious and exploring saves time in the long run. It also preserves trust.