Hostage Negotiation Tactics in Medical Communication

Mar 05, 2023 8:39 am

What you're about to unwrap in this month's newsletter

  • Beautiful scripting
  • The Shift KickAssery Workshop
  • 3 wickedly cool things you might enjoy

A Level Up on the Spock Retreat

Our most recent episode on The Spock Retreat explored how to tell patients "no" in an understanding way (with the bonus of avoiding complaints and escalation!) The scenario we used was the common ask for antibiotics by patients with viral upper respiratory tract infections. The pod breaks down several strategies on how to go about this and, much to my delight, good friend of the show Lon Setnik from the Center for Medical Simulation reached out with his take on the matter which is based on FBI hostage negotiator Chris Voss' techniques. Here it is...

A shift in mindset

Lon's mindset shift is from 'I have special knowledge to tell the patient - that viruses don’t need antibiotics', to 'THEY have special knowledge I need to understand.' The special knowledge in this case is what brought them to see him. It’s what’s behind why they want antibiotics.

How does he know when he understands their special knowledge? When the patient says, “That’s exactly right.” He tries to get there BEFORE the physical exam.

The script

Lon: “So you’ve got chills, congestion, cough, and have had 2 negative COVID swabs in the last 3 days. What’s on your mind?”

Patient: “I can’t be sick, I think I need an antibiotic.”

Lon: “Tell me more.”

Patient: “My husband has Parkinson’s, and we are going to Tanzania in 2 weeks, I can’t miss this trip! It’s a life goal of ours and we will never be able to do it again.”

Lon: “So you’re worried if you don’t get the antibiotics now, you’ll miss the trip?”

Patient: “Well, I’m not missing it no matter what, but I can’t be sick for it. I’ll be with a ton of people, many of who are older, and I can’t be contagious. I need to be better.”

Lon: “So you’re thinking if you get an antibiotic now it’ll make sure you aren’t contagious for the trip?"

Patient: “That’s exactly right.”

Lon “Alright, let’s do your exam!”

99% effective

Lon has found this works 99% of the time. The patient feels heard and he can address their actual fear, anxiety, and reason for coming. In this case, “You won’t be contagious in 2 weeks. You might still be coughing, but an antibiotic won’t change that, and you could get something like C. Diff from it that would throw everything out of whack.”

Rob O's take:

I love this.


The Flameproof Shift KickAssery Workshop

May 29, 2023

Scott Weingart and I are putting on the Flameproof: Shift KickAssery workshop at the Cosmopolitan Hotel, Las Vegas. 9a-1p. Limited space (intentionally). This is a PreCon for Essentials of Emergency Medicine. Register Here. The PreCon reg is halfway down the page.

Or if you like buttons, you can click this one:

Click to Register for the Flameproof Shift KickAssery Workshop

3 wickedly cool things you might enjoy


For years, I have used a manual bow saw to cut down small trees and tree branches. Then I borrowed this little gem from my neighbor and it was love at first sight. So fun and incredibly useful. I now own one.

An ED doc wanted to level up communication between his department and hospital leadership. He started a hospital handshake program and the results were incredible.

X-Waivers to treat opioid use disorder are a thing of the past.

What's on your mind?

If you're feeling stuck, burnt, overwhelmed, or simply want to level up your career, I specialize in 1-on-1 coaching for physicians and high-level performers. Learn more here.

Keep on rocking.

Rob O

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