Patients Aren’t Always Right—Are they?

“Patients are always right.”
A phrase that echoes through healthcare hallways, nursing stations, and sometimes even in hospital complaint boxes. Borrowed from the world of customer service—where “the customer is always right” is a sacred principle—it seems misapplied in the world of medicine.

Because medicine isn’t retail.
Doctors aren’t waiters.
And while patients deserve dignity, respect, and empathy—they’re not always right.

In this article, we dive into this tricky but necessary topic. We’ll explore where this myth originated, why it still persists, how it interferes with sound clinical practice, and when and how doctors should respectfully disagree. Most importantly, we’ll examine how to strike a balance between honoring the patient's voice and safeguarding the integrity of medical care.

1. Where Did This Phrase Come From—and Why Did We Adopt It?

The origin of the phrase “the customer is always right” traces back to early 20th-century marketing strategies aimed at consumer loyalty and satisfaction. In business, the model made sense—make the buyer feel heard, respected, and prioritized.

As healthcare evolved—especially in privatized and insurance-driven systems—patients were increasingly viewed through a business lens. Terms like “clients” and “consumers” began to replace “patients.” With that shift came an intense focus on satisfaction surveys, online reviews, and feedback scores.

Healthcare started to mirror hospitality.
Doctors became “providers.”
Patients became “customers.”
And complaints became corporate performance indicators.

While listening to patients is essential, equating them to paying clients risks undermining the ethical core of medicine. It replaces clinical reasoning with appeasement and reshapes complex decisions into simple customer service transactions.

2. Why the Patient Isn’t Always Right—Clinically Speaking

The core difference between patient beliefs and medical knowledge lies in training and responsibility.

Doctors are trained to:

• Integrate vast clinical data
  
  
• Spot nuanced symptom patterns
  
  
• Apply evidence-based practice
  
  
• Weigh risks and benefits that are invisible to the layperson
  
  
• Make rapid decisions under pressure
  

Patients, on the other hand, may:

• Rely heavily on search engines
  
  
• Base conclusions on anecdotal or viral content
  
  
• Enter consultations with preconceived self-diagnoses
  
  
• Misinterpret symptoms
  
  
• Insist on specific tests or treatments
  

A viral YouTube video or TikTok trend does not carry the weight of years of medical education. While informed patients can enrich the consultation, misinformation can derail it entirely. And worse—if followed—can lead to harm.

3. Common Scenarios Where Patients Are Not Right

Doctors often encounter scenarios that challenge the "always right" notion:

1. Demanding antibiotics for viral infections
   Patients insist on antibiotics for colds, flu, or COVID-like symptoms, despite knowing these are ineffective and harmful in such contexts.
   
   
2. Requesting unnecessary imaging
   Wanting CTs or MRIs “just in case” for benign issues like tension headaches, fueling radiation exposure and incidental findings.
   
   
3. Refusing proven treatments
   Choosing unverified “natural” remedies during serious conditions like sepsis or acute coronary syndrome.
   
   
4. Self-diagnosing from social media
   Believing they have rare conditions seen in online communities and pressuring for referrals to irrelevant specialties.
   
   
5. Threatening consequences for denial of requests
   Using legal threats or poor ratings to coerce prescriptions of opioids, stimulants, or benzodiazepines.
   
   
6. Misunderstanding correlation and causation
   Assuming a new symptom was caused by a vaccine, or crediting recovery to unproven supplements.
   

In each case, the physician’s responsibility isn’t to agree—it’s to lead. And sometimes, leadership means saying “no.”

4. The Emotional Challenge: Saying “No” Kindly

Rejecting a patient’s request is never easy. Even when medically correct, it can trigger a defensive or emotional response from patients who feel unheard or dismissed.

To say “no” with grace requires:

• Emotional intelligence
  
  
• Clear and empathetic communication
  
  
• Clinical confidence
  
  
• Risk awareness
  

Examples of tactful refusal include:

• “I understand why you’re asking for that, but based on what I see, it may not benefit you and could actually cause harm.”
  
  
• “That test isn’t likely to give us useful answers in your case. Here’s why.”
  
  
• “I’m here to help, and part of that is protecting you from things that won’t work or could make things worse.”
  

Even rejection, when delivered kindly, can build trust rather than erode it.

5. When the Phrase Hurts the Profession

When doctors say “yes” to everything:

• Overprescription becomes rampant
  
  
• Unnecessary imaging and referrals skyrocket
  
  
• Patients receive care that is driven by demand, not need
  
  
• Medical standards are diluted
  

This leads to consequences far beyond the consultation room. It contributes to:

• Increased healthcare costs
  
  
• Iatrogenic harm from avoidable interventions
  
  
• Rising malpractice risk
  

And worst of all—it feeds into burnout. Physicians feel:

• Undermined
  
  
• Morally conflicted
  
  
• Afraid of being reported for doing the right thing
  
  
• Pressured to compromise their integrity for popularity
  

Reducing medicine to customer service transforms healing into appeasement, and that’s a path toward professional disillusionment.

6. The Legal and Ethical Complexity

Respecting patient autonomy doesn’t mean surrendering clinical judgment. But declining a request can escalate into administrative or legal backlash.

Common consequences include:

• Formal complaints
  
  
• Poor patient satisfaction scores
  
  
• Threats of legal action
  
  
• Managerial scrutiny focused on appeasement, not ethics
  

That’s why documentation is critical. Doctors should thoroughly note:

• Clinical rationale for declining requests
  
  
• Educational conversation with the patient
  
  
• Potential risks explained
  
  
• Patient reaction and acceptance/refusal
  

Medical ethics obligate physicians to protect patients—not to validate every demand.

7. But—Patients Are Often Right About One Thing

Their lived experience.

While patients may not have medical expertise, they are experts in their own bodies. Their insights often point to underlying issues not yet captured in labs or scans.

Examples include:

• “This pain isn’t like before.”
  
  
• “I’m reacting badly to this medication.”
  
  
• “This just doesn’t feel normal.”
  
  
• “I’ve been to multiple doctors and something is still wrong.”
  
  
• “I’m scared, and I feel ignored.”
  

Validating these concerns doesn’t mean agreeing with self-diagnosis. It means listening actively and taking the patient seriously.

Respecting patient experience builds trust—even if the outcome isn’t exactly what they expected.

8. The Role of Shared Decision-Making

Shared decision-making (SDM) offers a middle ground. It shifts the model from obedience to partnership.

SDM includes:

• Acknowledging the patient's concerns and values
  
  
• Explaining the medical options and evidence
  
  
• Presenting benefits, risks, and alternatives
  
  
• Letting the patient be part of the decision—not just a recipient
  

It removes the tension from disagreement and transforms it into collaboration.

From “I’m the doctor, listen to me” to “Let’s solve this together.”

When used well, SDM improves satisfaction, compliance, and outcomes—all without compromising medical standards.

9. Teaching the Next Generation: Assertiveness with Empathy

Medical students and young residents are often taught to avoid conflict. They’re encouraged to over-explain, over-accommodate, and fear complaints.

But we must also teach them how to:

• Stand firm in scientific reasoning
  
  
• Identify manipulation or coercion
  
  
• Decline requests calmly and ethically
  
  
• Be assertive without being dismissive
  

This isn’t arrogance—it’s professionalism.

Assertiveness combined with empathy protects both patient and physician. It preserves trust while maintaining the quality of care.

10. Final Thoughts: Dismantling the Myth with Compassion

“Patients are always right” belongs in hospitality, not healthcare.

In medicine, that mindset:

• Fosters dangerous overuse
  
  
• Fuels physician burnout
  
  
• Erodes clinical judgment
  
  
• Sets unrealistic patient expectations
  
  
• Damages trust when outcomes fall short
  

A better principle?

“Patients always deserve to be heard. But safe care doesn’t always mean saying yes.”

Doctors are not gatekeepers—they are protectors, educators, and partners.

In a world of medical misinformation, fear, and instant gratification, saying “no” with compassion is one of the most vital skills a modern physician can master.

It may not be what the patient wants in the moment—but it may be exactly what they need.