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How to talk to patients in the hospital who want a new doctor

Patient concerns about pain management and discharge plans are often behind requests for a new doctor

July 2024

WHAT WORKS TO CONVINCE patients to not “fire” their doctor in specific situations? Sources offer the following tips to prevent dismissals:

• Pain management: “It often takes a bit of time but we work to educate the patient about why we are doing what we’re doing,” says Ijeoma Carol Nwelue, MD, chief of hospital medicine at Baylor Scott & White All Saints Medical Center in Ft. Worth, Texas. “If we feel there is room to adjust their dosing, we absolutely will do that. But we also set clear guidelines, saying things like ,’OK, at this point in your disease process, we would expect your requirements to be decreasing. So on this date, we will likely start to wean you off or increase the time between doses.’ It always helps to have those conversations ahead of time so patients know what to expect.”

• Getting on the same page: “If there is another specialist involved—say the patient just had surgery or another painful procedure—we will consult with the other physicians on the care team and make sure we all agree with what the treatment plan should be,” says Dr. Nwelue. “Ideally, we try to go into the patient’s room with that specialist so they’re aware that we’re all on the same page, and that can be helpful.”

“This is probably the most frequent reason why patients request a different doctor—they don’t want to go home.”

Ijeoma Carol Nwelue, MD
Baylor Scott & White All Saints Medical Center

• Disputes over discharge: “This is probably the most frequent reason why patients request a different doctor—they don’t want to go home,” points out Dr. Nwelue. “We’ll draw on the same resources that we do with such requests: We’ll talk with the patient and family—and potentially get a second opinion from another hospitalist service.”

If patients are considering dismissals, it also helps if you can tell patients that you’ve spoken to their outpatient providers. “Being able to say, ‘I talked to your primary care doctor or your cardiologist and let them know how you are doing. The inpatient portion of your care is now complete but we know you’re going to need to be monitored as an outpatient before you feel like yourself. We’ve discussed what happened in the hospital, and they will receive a summary of everything we’ve done so, when they see you in the clinic, they can pick right up where we left off.’ ”

• Dissatisfaction with another physician: It’s much more common for patients to have a reservation about the physician who has been treating them without getting to the point of making an actual request to switch providers. As Naznin Jamal, MD, hospitalist medical director at Jefferson Regional Medical Center in Pine Bluff, Ark., points out, that’s something that doctors hear when they, on the day they begin their seven days on service, take over from a previous physician.

“Because of seven-on/seven-off, we already change doctors without anyone being fired,” says Dr. Jamal. “What often helps is just listening to patients, letting them talk, hearing what their priorities are and how communication with their previous provider may need to be strengthened.”