One of the most valuable things I learned in business school was how to be a better negotiator. Negotiation skills are helpful not only for job contracts, but also for many areas of life. Negotiating with your vendors, employees, health plans, and even spouse or children can be a fruitful experience. Indeed, using good negotiation techniques with your patients can help you optimize the best care with the best service whether in person or virtually.
The three principles I want you to understand are:
1. Negotiate on interests, not positions.
2. Frame or be framed.
3. Win/Win is not only possible; it is the most likely outcome of good negotiating.
Let’s use an example to illustrate each of these: If a patient comes to you asking for Vicodin (hydrocodone and acetaminophen) because you froze actinic keratoses, your first instinct might be to think this patient is a drug seeker and that he is not going to be satisfied unless you give in to his demand. You are a conscientious doctor and never prescribe narcotics for liquid nitrogen treatments. Here, you’ve just locked into a position, and there is no opportunity for negotiation. Instead, take a different approach – consider interests, not positions.
Positions are what you’ve decided. Interests, in contrast, are the reasons why you came to that decision. Think about both your interests and your patient’s interests. The patient wants something to block pain. You want to provide appropriate, safe care. In this instance, ask him why he wants Vicodin; probe about issues that might underlie his request. Keep asking until you feel you understand his interests. This is critical to good negotiation. Then think about your interests. You don’t want your patient to be in pain, and you don’t want to feed a patient’s dependency problem or risk your license for inappropriate drug dispensing.
Second, frame the problem (as you see it) or risk being framed by your patient. Your patient might see you as uncaring and unwilling to help him. You can change this by reframing yourself as the doctor who actually does care. For example, you might say, “I’m concerned about you. Taking Vicodin for this is not normal, and this drug is notorious for leading people into drug dependency. I don’t want to expose you to that risk.” Here, you have taken control of the frame and presented yourself as concerned rather than uncaring.
Third, in almost every negotiation there is an opportunity to expand the pie. That is, each party can offer something that was not in the original discussion but would benefit both. In this instance, you might offer to give the patient samples of a topical treatment for actinic keratoses. The patient, sensing your genuine concern, might offer to bring his mother to you for skin cancer treatment as she, too, is particularly sensitive to pain.
Of course, not all negotiations end in agreement. Sometimes your best option is to reject the request. If your patient is unwilling to compromise, then your best course of action might be to not treat him at all. Before doing so, remember that you will often have a better outcome if you try to reach agreement and that using sound negotiating practice will be a significant advantage. (Please, just don’t tell my wife about this column.)
Dr. Benabio is a partner physician in the department of dermatology of the Southern California Permanente Group in San Diego and a volunteer clinical assistant professor at the University of California, San Diego. Dr. Benabio is @dermdoc on Twitter. Write to him at dermnews@frontlinemedcom.com.
