A 34-year-old man calls the office requesting an urgent appointment due to cough and cold symptoms. His temperature is 37.2 C (99 F), but he feels "miserable" and is unsure if he should go to work the next day. The patient has a history of seasonal allergies and knee pain from a past sports injury. He has no other medical problems but does have a history of frequent office visits. The receptionist informs him that the physician is preparing to leave as it is near closing time but that an appointment is available for the next morning. The patient declines the offer of an appointment and hangs up. As the physician leaves the office 30 minutes later to make evening rounds at the hospital, the patient arrives and insists on being seen immediately. He sounds congested and coughs occasionally but is breathing normally. He has no other symptoms. He again asks to be examined. Which of the following is the most appropriate response?

Question

A 34-year-old man calls the office requesting an urgent appointment due to cough and cold symptoms.  His temperature is 37.2 C (99 F), but he feels "miserable" and is unsure if he should go to work the next day.  The patient has a history of seasonal allergies and knee pain from a past sports injury.  He has no other medical problems but does have a history of frequent office visits.  The receptionist informs him that the physician is preparing to leave as it is near closing time but that an appointment is available for the next morning.  The patient declines the offer of an appointment and hangs up.  As the physician leaves the office 30 minutes later to make evening rounds at the hospital, the patient arrives and insists on being seen immediately.  He sounds congested and coughs occasionally but is breathing normally.  He has no other symptoms.  He again asks to be examined.  Which of the following is the most appropriate response?

Quizplus · Accepted Answer

This physician is faced with a patient who inappropriately demands to be seen after hours for a non-urgent concern. A stable patient who fails to arrive at the appointed time should be advised to reschedule the appointment; the physician is under no obligation to immediately see this patient. Performing an examination after hours is inappropriate and reinforces the patient's sense of entitlement and poor boundaries. Acquiescing to the patient's demands would only encourage similar behavior in the future and create further tension in the physician-patient relationship due to the patient's lack of respect for the physician's time (Choice F). The most appropriate response is to calmly set limits and establish clear professional boundaries. The physician should explain in a polite yet firm tone that the examination will be deferred until the next day because the condition is not an emergency. (Choice B) This response suggests that the patient's behavior is appropriate and offers an excuse not to see the patient rather than explaining that non-emergency concerns can wait. (Choices C and E) These responses set limits but are dismissive of the patient's concerns. It is better to acknowledge the concerns but explain that non-urgent issues are addressed during regular office hours. (Choice D) Recommending that the patient go to the emergency department for a non-urgent condition is inappropriate and places an unnecessary burden on emergency services. Educational objective: Physicians should respond politely but firmly to inappropriate patient requests. Maintaining professional boundaries is an important component of the physician-patient relationship. References: Managing difficult encounters: understanding physician, patient, and situational factors. (http://www.ncbi.nlm.nih.gov/pubmed/23547575)

A 34-Year-Old Man Calls the Office Requesting an Urgent Appointment