Moving Us Closer To Osler
A Miller Coulson Academy of Clinical Excellence Initiative

How do you work with a reluctant patient?


Read insights from a psychiatrist, chemical dependency specialist, critical care specialist, primary care provider, and a pediatrician.

Connecting with Patients | April 27, 2018 | <1 min read


Margaret Chisolm, MD, Johns Hopkins University School of Medicine

For years I was mystified that whenever I was seeing a new patient for the first time, he/she would begin the meeting by announcing, “I have no interest in being on an antidepressant medication and am here for psychotherapy only.”

I had no problem with that, and would spend the next 90 minutes or so getting to know the patient’s history and conducting an examination so as to develop a treatment plan. After which, if the patient had major depression, I would often say something like, “I know you’re not interested in medication—which I would typically recommend for depression—so let’s discuss alternative treatments.”

At which point the patient would say, “Oh, if you think I need a medication, I’m okay with that.”

It turns out I was on the Mood Disorders Consultation Clinic’s list as a psychiatrist to refer patients who didn’t want to be on medication. So, that solved the first mystery: why I was seeing so many patients who were initially not interested in medication.

But the second mystery—why after spending 90 minutes answering my questions, the patients changed their mind and were open to medication—was more puzzling.

I came to the conclusion that several factors are at play:

1.) The patient hearing him/herself recounting his/her story out loud is persuasive that something is seriously wrong for which medication might be helpful.

2.) My attentive listening to his/her story and concluding that medication would be helpful (if it would be) is persuasive; and – most importantly –

3.) My openness to giving the patient the autonomy to choose to take a medication or not empowers him/her to make a decision without feeling pressured to do so.

So, when faced with a reluctant patient, I would say:

Listen attentively to the patient telling his/her story and then share benefits, risks, and alternatives to various treatments, while giving the patient the dignity of making his/her own choice.

Mike Fingerhood, MD, Johns Hopkins University School of Medicine

1.) Ask, “Is there something I can do to help us work together on this?”

2.) Make sure your patient understands the purpose of what you’re trying to work with them on.

3.) Make sure your patient understands the reason for the needed action/test/intervention.

What do you think?

Do you want to add to the conversation? Please share!

Panagis Galiatsatos, MD, Johns Hopkins University School of Medicine

A reluctant patient has more concerns then what’s currently visible in the immediate situation.

Taking time to unmask these issues is the start to forming a strong relationship with your patient.

1.) Get to know the patient, where they’re coming from, and what they hope to achieve.

2.) Align your health goals with their goals.

Steven Kravet, MD, Johns Hopkins Community Physicians

I always start by building trust.

I don’t embark on difficult conversations until there is a rapport and trust.

Michael Crocetti, MD, Johns Hopkins Community Physicans

When I sense reluctance the first thing I do is stop talking, relax my body, sit at the level of the patient, and simply listen.

Listening to patients tell their story can mitigate so much of their concern and unlock things you didn’t even consider.

Once you’ve really listened, now you’re prepared to address the reluctance and come to common ground with your patient.