As a physician assistant (PA), you’re familiar with patients who need to start a medication regimen. Often, you may have patients who want to weigh in on medication suggestions.

“During your interactions with patients, some may be set on receiving certain medications for their diagnosis, and it’s not uncommon for PAs to encounter patients who have strong preferences for certain medications and may be resistant to alternative treatments,” said Alisha Bradshaw, PA-C, a physician assistant in family practice at Johns Hopkins Community Physicians Charles County in White Plains, Maryland. As a PA, here are some guidelines that may help you navigate such expectations:

Why Do Patients Want Specific Medications?

Patients often come with preconceived notions about certain medications, influenced by personal experiences, media and advertising, or even anecdotal stories, said Bradshaw. Therefore, it is important as a medical provider to understand a patient’s perspective.

“It’s critical for PAs to approach these situations with empathy and active listening,” she said.

A possible scenario involves prescribing antibiotics.

“Patients often think they need antibiotics to treat viral illnesses,” said Carmel A. McComiskey, DNP, associate chief clinical officer, director, Nurse Practitioners and Physician Assistants at University of Maryland Medical Center Downtown and Midtown Campuses in Baltimore. “This requires that the nurse practitioner or physician assistant engage in a conversation, armed with the current evidence to support best therapies.”

As an example, McComiskey recommends a discussion with a patient to explain how antibiotics are not always a go-to. “Discuss antibiotic stewardship and the problems that arise when inappropriate antibiotics are utilized, which cause resistance and cause resistant bacteria to develop as is the case with MRSA (methicillin-resistant Staphylococcus aureus) in the community,” she said.

Some Potential Approaches to Use

Listen with intent. As a PA, you should be willing to build trust and be open to communicating with the patient. “The foundation of effective patient care is trust. When patients feel heard, they’re more likely to be open to alternative suggestions,” said Bradshaw.

Validate their opinion. Clinicians can foster this trust by validating the patient’s concerns through clear, evidence-based explanations. “This approach is undergirded by our willingness to communicate with the patient and not at the patient. It is important for the patient to feel a part of the process,” she said.

Educate and collaborate. After listening, educate your patient by explaining the medical reasoning behind why a certain medication may not be necessary. “PAs can use simple language, share relevant data, and even provide examples or analogies to help the patient better understand why a different course of action is being offered,” said Bradshaw. “It’s about making the patient feel informed rather than dismissed.”

Use reflective listening. If a patient is adamant about medication, it’s important to be patient. Use reflective listening, repeating back what the patient has said to show understanding, which reassures a patient that their concerns are being taken seriously, and you hear them, Bradshaw said.

Build a partnership. Collaborate on a care plan that respects the patient’s preferences while ensuring the best possible outcomes. Once a patient feels a part of the decision-making process, they will be open to considering your alternative suggestions, she said. “PAs can effectively guide patients toward better health outcomes while respecting their autonomy. The key is balancing clinical expertise with compassionate care,” Bradshaw said.

Keep your composure. Your demeanor is crucial in navigating patients’ expectations. A calm, compassionate, and confident approach can help establish trust and credibility, said Bradshaw. “When a PA maintains a professional and empathetic tone, it can help diffuse tension and encourage the patient to be more open to discussion,” she said. Calmly explaining medical reasoning can help keep the upper hand in the interaction, she said.

Stand your ethical ground. There’s a moral responsibility, and you must use your medical knowledge and practices to know when to say, “no.” “You are not obligated to provide unnecessary and inappropriate care,” Bradshaw said.