You Can Say No

When I suggest a lab test or a new prescription, you get the final say. I’ll give you my honest opinion, and then you decide. I want every patient at Cove to feel comfortable asking me about a recommendation, and just as comfortable telling me they’ll pass on it.

Plenty of people have walked out of a clinic with a stack of orders and only a fuzzy idea of why they need any of them. I want you to leave Cove knowing what I suggested and why I suggested it. Here is how I try to handle that in the exam room.

Why I’m suggesting it

Any time I recommend something, I should be able to tie it back to what you came in for. Say you tell me you’re worn out by two in the afternoon, and you’d like enough energy to keep up with your grandkids on the weekend. If I want to check a couple of labs, I’ll tell you what I’m looking for and what we would do differently depending on the results. If I can’t connect a test to your goals, I probably shouldn’t be ordering it.

What it costs

I’ll also tell you what it costs you. Money is part of that, and so is the hassle. A referral might mean a drive out of town and half a day off work. A new medicine might mean a pill every morning for years. You should hear about those things before you agree to anything.

Whenever you ask, I’m glad to tell you what something costs, so you’ll know the number before you make up your mind. Screening labs are included with your annual wellness exam, and additional labs are at wholesale prices.

If you wait or skip it

I’ll give you my best guess about what happens if you wait or skip it. For a lot of things, waiting a few months is fine, and I’ll tell you what to keep an eye on in the meantime. For a few things, waiting worries me, and I’ll say so.

Coming back to it later

A lot of the time, people mean “maybe later.” Money might be tight this month. Or you’d like to try walking after supper for a couple of months before you start a blood pressure pill. Those are good reasons, and I’m glad to hear them.

Your membership is a flat monthly fee, so bringing something up again won’t cost you extra. Mention it at your next visit, or call us next week and we’ll talk it over. If we agree to come back to it in the spring, I’ll make a note in your chart and we’ll pick it up in the spring. You can ask me the same question twice, or five times, and there won’t be a charge for that either.

How sure I am

I’ll also tell you how strongly I feel. Once in a while I’m worried about something. When that happens I’ll say it plainly and explain my reasons.

A lot of primary care comes down to judgment, though. Two careful clinicians could look at the same numbers and suggest different things. When it’s a close call, I’ll tell you it’s close, and we’ll talk about which way fits your life better.

You may find I suggest less than you expected. My advice might be to keep an eye on it and recheck in a few months, or to run one test that answers the question. The cheaper option may also be somewhere other than Cove. If the pharmacy down the street has a better cash price on your medicine, I’ll tell you to fill it there, and I’m happy to call around and compare. If you need an x-ray or other imaging, I’ll send you to an outside imaging center, and I’ll point you to one with a lower price when I can.

What I tell new patients

When I meet a new patient, I try to say this early on:

“If I ever recommend something and you’re unsure about it, ask me. And if you decide it’s not for you, that’s okay too. I’ll never pressure you into something or make you feel bad for passing on it. If you ever feel that way, I haven’t done my job.”

I mean it. You can ask me to explain something a second time, or tell me you want to sleep on it. Neither one bothers me, and it won’t change how I take care of you.

I became a family nurse practitioner because I wanted to know my patients well enough to give advice that fits their lives. That only works if you’re honest with me. If you nod along in the exam room and then skip the plan at home, I’d have no way of knowing what went wrong. I’d much rather you tell me a plan won’t work for you, so we can come up with one that will.

If you’d like to meet me and see whether Cove is a good fit, you can book a Meet & Greet, or call us at (812) 227-6024.

Personal primary care.

— Will Pumphrey, FNP-C