Fielding inappropriate patient requests and getting to "No" while preserving rapport with a patient is an essential clinical skill. AAFP has a 5-step approach.
"Would you refill my Xanax prescription?" "Can you order an MRI to see what's causing these headaches?" "I think my mother needs a wheelchair once she's home."
For some patients each one of these requests may be entirely appropriate but for others, in your clinical judgement, they may be unnecessary or entirely inappropriate. How a clinician manages the conversation around those requests and reaches the answer, "No," can affect the relationship with the patient as well as the physician's own sense of professionalism.
A 5-step approach endorsed by the American Academy of Family Physicians abbreviated as FAVER, can help clinicians build awareness of their own discomfort in these situations, minimize conflict with patients, and maximize quality of care: Feelings Analyze View Effectively Reestablish Rapport. The following slides provide a topline tutorial.
EXPLICITLY... state why the request is inappropriate. It may be poor medical care, illegal, dishonest, or against policy.
EXPLICITLY... state why the request is in appropriate - but try to avoid doing something "just a little" dishonest.
Reference: Kane M, Chambliss L. Getting to no: how to respond to inappropriate patient requests. Fam Pract Manage. 2018;25:25-30.