Joel Salinas
Harvard Medical School, USA
Title: Autonomy and the “Demanding Encounter†in clinical neurology
Biography
Biography: Joel Salinas
Abstract
We describe a case of psychogenic non-epileptic seizures (PNES) as an example of what has been called the “demanding encounter” in clinical neurology. Patients in these encounters are more likely to see themselves as informed consumers who expect to receive requested diagnostic tests and treatments from healthcare providers, potentially creating a conflict over treatment goals and appropriate limit setting. “Demanding encounters” are associated with physician burnout and patient dissatisfaction. We survey some of the ethical frameworks introduced to navigate this type of encounter. We argue that physicians are obligated to identify the underlying beliefs that are leading to requests for unnecessary testing and treatment and that, by addressing these beliefs, providers have the best chance of establishing a respectful, meaningful therapeutic relationship with their patients.