Episode 18: Managing Unrealistic Expectations — Mark Green, MD

Every practicing physician has had the experience of feeling powerless in the face of patient expectations that come across as overblown or unrealistic. Addiction psychiatrist Mark Green, MD, shares with Drs. Curious and Schwab that an effective strategy for managing such expectations is for the health professional to join with the patient by acknowledging their shared experience of powerlessness. In this episode, Dr. Green reflects on the work he has done helping primary care physicians manage challenging patients with chronic pain and so-called “drug-seeking behavior.” He observes that sometimes physicians who are rushed for time and feel compelled to “do something” may inadvertently end up hurting their patients, rather than helping. Sadly, this problematic dynamic may be one of the root causes of the opioid epidemic. Although patients may expect physicians to alleviate their pain and meet other expectations, it is the professional’s job to help them differentiate between unrealistic hopes and achievable goals. By taking time to listen to patients and gain a deeper understanding of the causes of their distress, it is sometimes possible to accomplish more by doing less (fewer unnecessary tests, less medication). Empathically engaging with patients, understanding their helplessness, and sharing in patients’ powerlessness all may reduce their suffering, loneliness, and desperation. Although Dr. Green acknowledges that taking the time to forge these kinds of connections to patients may be draining to the professional, he describes it as potentially fulfilling and even invigorating. In fact, he believes that burnout ensues when physicians and other professionals find themselves in practice situations that deprive them of the opportunity to connect with and listen to their patients. Dr. Green recommends acknowledging one’s powerlessness as an act of self-compassion. His counterintuitive perspective provides Marie and Les with much food for thought.