There have been a handful of times in my career as a nurse practitioner (NP) where I’ve had patients who challenged my sense of confidence in my role. One particular patient comes to mind.
I was working at a community mental health center at the time and this patient was in her mid thirties. She was presenting for ongoing mood lability and throughout the initial psychiatric evaluation, she was peppering me with questions about medications before I could complete the assessment. Many times I needed to gently redirect her back to my questions, often explaining why I was asking what I was asking. She was assessing my ability to do my job as I was doing it.
After I conducted my assessment and proceeded to discuss my impressions and treatment recommendations, this patient expressed significant doubt over most everything I shared. I’m a very collaborative provider and feel the best treatment occurs when transparency, trust, and clear impressions are provided so collaboration on treatment can occur. We weren’t in this space of trust.
While not explicitly stated, this patient didn’t trust me as a provider. It might have been some aspect of myself – age, appearance, non-verbal communication – that affected her response to me but I got the sense that much of her hesitancy came from seeing me as a nurse practitioner instead of as a physician. I wondered how this psychiatric evaluation would have proceeded if I had been a psychiatrist instead.
3 ways to handle situations where patients don’t want to see you as an NP
1. Begin your initial visit by explaining your role as an NP.
No Shakespearean monologues needed, but not all patients understand our roles as nurse practitioners in healthcare. So it’s helpful to begin initial visits with a brief introduction of your role and how you’ll help them today.
I usually start my initial psychiatric evaluations with all new patients by stating something along the lines of “Im Claire Ellerbrock, I’m a psychiatric nurse practitioner and I’m looking forward to seeing how best I can help you today, possibly with medications. Just to shed more light if you’ve never worked with a nurse practitioner, I am an advanced practice nurse – which means I have gone to school for further training – to diagnose and treat conditions with medications. If you have no initial questions for me about that, I’d love to know, what’s bringing you in to see me today?”.
I want to acknowledge that explaining your role to patients at times can feel discrediting but not all patients have worked with NPs before and providing succinct clarity of your role is a great way to start a visit.
It’s important to briefly explain your role at the beginning because if a patient doesn’t want to see an NP after that initial introduction of who you are, the session concludes without wasting your time assessing and your patient’s time sharing. I’ve definitely had a patient once who, halfway through the assessment, asked me to clarify my role again, and upon realizing I wasn’t a psychiatrist, she wanted to conclude the assessment. This left me with a half completed psych eval that I still needed to complete including the risk assessment without any follow up or the patient being helped. Don’t let this happen to you.
Patients do have a right to see the type of provider they wish to see; there’s no obligation that a patient should have to see a nurse practitioner, or physician, for that matter. That brings me to my next point on how to handle patients who may not want to see you as an NP.
2. Understand that not all patients want to see NPs.
This one’s important but can be hard to detach yourself from personally.
Often a patient’s desire to see a physician instead of an NP has nothing to do with you but rather society’s familiarity with physicians. Remember, our roles haven’t been around for hundreds of years. NP schools have been around for less than 60 years. In fact, the first nurse practitioner program was created in 1965. The first medical school was established in 1765. That’s 200 years of development medical schools have had to create the role of physician and for the public to understand who they are. With this history in mind, you can see why some patients may prefer to see a physician. We’re all more comfortable with what we know.
Fortunately for patients, evidence shows that nurse practitioners produce similar patient outcomes as our physician colleagues so patients will be in good hands, whoever they choose to see.
And for those of us who want a bit more comfort that NPs really do provide outstanding care, the research very clearly backs this up. One systematic review of ten randomized controlled trials (RCTs) found that NPs demonstrated “equal or better outcomes than physician groups for physiologic measures, patient satisfaction, and cost”.
Another systematic review conducted in 2021 reviewed 13 RCTs in primary care and hospital settings and found that NPs “enhance patient care, service cost-effectiveness, efficiency, and general patient satisfaction with the overall quality of care provided”. Outcomes are similar to our physician colleagues, and on some metrics, do even better.
Undeniably, NPs provide high quality care; it’s important to keep this in mind when you come across the rare patient who prefers to see a physician instead.
3. Debrief difficult encounters.
We’re all human, though. And whenever someone rejects us, it’s hard not to take it personally. That’s why it’s critical to debrief difficult encounters with trusted colleagues who believe in your abilities and can validate your experiences. There’s nothing more doubt-creating than having a challenging patient interaction and not having anyone to talk to afterward.
As someone who’s more conflict-adverse, whenever confrontation occurs with patients, I tend to go down a rabbit hole of doubting myself – do I really know what I’m talking about? Maybe my patient was right in needing a stimulant, benzodiazepine, and a pony…
This train of thought can easily be interrupted if you talk to a colleague who knows your value and can help put the difficult encounter in perspective. Oftentimes, patients behave in ways that don’t necessarily relate to anything we’re doing. Talking to a colleague can help you remain objective and also validate your feelings.
Don’t forget – while you might not be a good fit for every patient, you bring incredible value to the patients you serve.
Hopefully these tips will help you gracefully handle these rare times when patients prefer to see a physician instead.
If you’re looking to delve deeper in practicing more stress-free, check out how quality charting makes you the most well-liked provider (and keeps you happy too) and also my free training on diagnosing and treating mental disorders.
