Massachusetts Medical Society: Episode 18: Managing Unrealistic Expectations

Episode 18: Managing Unrealistic Expectations

Managing Unrealistic Expectations

Course Overview

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. 

Learning Objectives

  • Learn ways to address patient expectations in a respectable and caring manner.
    • Recognize the powerlessness that both physicians and patients experience when there is pressure to have all patient concerns alleviated. Helping patients identify achievable goals may strengthen the doctor-patient relationship.


      Mark Green, MD
      I’m a psychiatrist, psychotherapist, and psychopharmacologist. My approach to psychotherapy is relational, pragmatic, structured, direct, and emotionally vivid. As a psychopharmacologist, I shape treatments in a modern way, without taking undue risks. I utilize what’s tried and tested, imaginatively minimizing side effects. I’m trained in many modalities: psychoanalytic, cognitive behavioral, solution-focused, motivational, hypnosis, and others. I’ve also been trained in AEDP (Accelerated Experiential Dynamic Psychotherapy). 

      After training in neurobiology with highest honors, I completed my medical degree at University College London. I came to the United States to train in psychiatry and addiction (Payne Whitney Clinic, New York Presbyterian Hospital, Cornell Medical Center), and have done research in the neurobiology of addiction at Rockefeller University. I have been a faculty member at Cornell, Vermont, and, Harvard Medical Schools. I am dually boarded by the American Board of Psychiatry and Neurology in general psychiatry and addiction psychiatry. 

      Since graduating in 1999, I have established and led addiction treatment programs (NYC, Vermont), directed evidence-based dual disorders programs, overhauled national addiction and pain programs (Kaiser Permanente, Colorado), and treated thousands of patients. I have written articles in neurobiology, psychiatry, and addictions, and have lectured at major conferences nationwide. I am especially interested in helping other physicians provide excellent and compassionate care to patients with chronic pain and opioid misuse. 

      Course Fees

      Massachusetts Medical Society (MMS) Member: Free       
      Non-MMS Member: Free       
      Allied Health Professionals: Free



      CME Credit

      1.00 AMA PRA Category 1 Credit™

      Accreditation Statement

      This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of the Massachusetts Medical Society and Physician Health Services, Inc. The Massachusetts Medical Society is accredited by the ACCME to provide continuing medical education for physicians. 

      AMA Credit Designation Statement

      The Massachusetts Medical Society designates this enduring material for a maximum of 1.00 AMA PRA Category 1 Credit™.  Physicians should claim only the credit commensurate with the extent of their participation in the activity.

      This activity meets the criteria for the Massachusetts Board of Registration in Medicine for risk management study.

      National Commission on Certification of Physician Assistants (NCCPA).
      Physician Assistants may claim a maximum of 1.00 Category 1 credit for completing this activity. NCCPA accepts AMA PRA Category 1 Credit™ from organizations accredited by ACCME or a recognized state medical society.

      Exam/Assessment: Please respond to the reflective statement at the end of the course to receive AMA PRA Category 1 Credits.

       MOC Approval Statement
      Through the American Board of Medical Specialties ("ABMS") ongoing commitment to increase access to practice relevant Maintenance of Certification ("MOC") Activities through the ABMS Continuing Certification Directory , this activity has met the requirements as an MOC Part II CME Activity (apply toward general CME requirement) for the following ABMS Member Boards:

      Allergy and Immunology
      Family Medicine
      Medical Genetics and Genomics
      Nuclear Medicine
      Physical Medicine and Rehabilitation
      Plastic Surgery
      Preventive Medicine
      Psychiatry & Neurology
      Thoracic Surgery

      Activity Term

      Original Release Date: January 24, 2019        
      Review Date: January 24, 2021           
      Termination Date: January 24, 2022

      System Requirements

      Windows 10        
      Mac OSX 10.6 higher

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