How to be firm on what I need without causing offense?

Question

At least once a week, I have to get blood drawn to comply with a treatment regimen. I don't have a problem with this. I'm not afraid of needles.

The trouble is that I can't always have the same person draw me.

Someone who has worked with me before knows that using the smallest needle is most effective and won't cause me pain.

When my preferred phlebotomist isn't available, I am still required to stay on schedule and have the blood work done.

I always make a point of insisting that the smaller needle be used, but this doesn't go over well with everyone. There have been several instances where I've had someone grant my request, but they were clearly not too happy about it.

My question is: How can I be firm on what I need without coming across as insolent?

I can sympathize with the people who don't like my request. From my own work experience, I understand how frustrating it is to have someone tell you how to do your job when they are the one asking for help.

However, I've had this procedure done more times than I can recall, and I know what works for me based on several painful experiences.

Maintaining a good relationship with anyone who cares for me is important because I may have to accept help from that person again in the future.

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Clarifications:

• The small needle is referred to as a "butterfly"

• I think they may be reluctant to use the small needle because they tend to have a more limited supply of these, and they are typically used on children.

• The procedure doesn't seem to take much time at all with the small needle.

• It's not a hospital setting. Every time I go to the facility, I have to present a copy of my insurance card and a doctor's order. If there is any kind of chart system, I've never seen it.

• The suggestion to refer to my preferred phlebotomist by name may work the best. There are very few staff members, and they seem to know each other well.

Answer 1

Medical personnel definitely do not appreciate patients telling them how to do their job. As you can imagine, the rise of the internet means people Google their symptoms and many doctors have lost patience with people who won't listen to their expert opinion because they have already convinced themselves they have something else.

On the other hand, when a patient has a long-term condition as you do, it is expected that you would know more about that condition that most, and more importantly you know yourself and how you react to treatment etc.

As you say, you have tried asserting yourself and it hasn't been well received by everyone. It would seem the problem is more their attitude than yours. However you can probably soften what you say to make it more readily received.

• Make sure it is clear what you say comes from your own experience, and not your opinion or the opinion of the internet.
• Also it would likely help if what you say reflects the findings of the medical staff who have treated your previously.

Don't wait until they have the wrong needle out. Perhaps while you are getting ready, taking your shirt off or whatever, say:

I'm sure this is in my notes, but your colleagues have had problems using the larger needles on me, they always say they have to use the smallest kind.

Hopefully this will get the best reaction. You haven't stated that this is your opinion, you have shown that this is from past experience and that their colleagues have introduced the use of the smaller needles. I think that this is as respectful of their expertise as you can be at this stage.

If however they object and you really want to assert yourself to avoid the unnecessary pain, you may have to say:

I mean no offence, but can I see the phlebotomist I saw previously? They know not to use the larger needle on me. It really hurt and I don't want to go through that again.

I would hope that stating you have experienced pain in the past would stop them, especially in the litigious culture in which we now live. You may have to be prepared for the fact that you might irritate a few phlebotomists along the way, but worth it to feel no pain.

Answer 2

In an ideal world any practitioner should be open to the views of their patient, but in practice, in busy situations and where there is a degree of standardisation to the procedure it can be more difficult for patients to get the recognition of the benefit of deviating from the standard.

Your experience is that you make a request and they push back. As far as they are concerned at that point they wield the needle and all negotiations are over.

Don’t negotiate, your position is absolute so you have no halfway house, you need instead to persuade them to agree.

You can find some wider discussion of persuasion techniques in this New Scientist article The Power of persuasion, available without a paywall here

If you aren’t going to negotiate, you need to do what you can to make it easy for staff to fall in with your wishes. The best solution would be to get the systems of the facility to work for you rather than against you.

If you haven’t already done so, find out if there is a way to get the information added to your file/case notes so that whoever is seeing you for any given appointment gets the maximum warning that they may need to tool up differently and the smaller gauge needle is your default situation.

If that can’t be done, because reasons, don't necessarily accept that at first pass. 'Reasons' might just mean it's a bit of a hassle. Frame the proposition that failing to get you phlebotomy appointment carried acceptably is also going to be hassle for the facility, but all the time reminding them how easy the solution is. But if they won't budge on that then information is your next best ammunition.

Gathering information doesn’t necessarily mean arrive armed to the teeth with data you have gleaned online, waving information of unverified provenance risks seeming oppositional, which only sets up the possibility of staff pushing back, so stay local. Get you info from your favourite phlebotomist.

Gather information from your phlebotomist about the reasons the small needle is better for you, ask them if there are downsides to the smaller needle.

EG What is the gauge or other designation of your preferred needle, do they routinely have them available at their station, does it take longer – perhaps needing a slightly longer appointment slot, are they harder to use, does it compromise the treatment/sample in any way. You’ll have a better idea than me of the sort of info that’s appropriate.

The aim is to equip yourself with enough information that you can minimise the hassle for the phlebotomists who don’t know you as well or are less inclined to credit your request.

Share information: as other answers have recognised, the earlier the better. If the info can’t be added to your file, ask the helpful Phlebotomists if they can mention it t their colleagues.

Be prepared to mention it at every stage of making your appointment, checking in at reception, before you sit down at their station.

Notice I’m saying ‘mention it’ not ‘ask if they will’. If you frame something as a routine requirement that you have an expectation of them meeting, rather than a ‘special request’ that’s at their discretion you subliminally prime people to fall in step: So

Hi, I’m Joe Bloggs here for my 9am in Phlebotomy, that’s the one that will be set up with an x gauge kit.

rather than

Hi, Joe Bloggs for my 9am, could you remind them I asked if they wouldn't mind getting a smaller needle for me?

Answer 3

1. Ask your preferred phlebotomist to make a note on your file.
2. If you get someone else, mention the file and briefly summarize the reason.

Just a heads up, previously there have been issues when using the common needles. To avoid these issues, X and I agreed to use needles size Y for the last Z [months/years]. It's on my file.

You do not need to tell them what to do - you inform them of the circumstances, and you use the name of the other phlebotomist and mention the file to raise your credibility. You also use the correct term for the needle both for accuracy and to gain credibility.

If they then chose to ignore you, you can either try telling them what to do, or ask for a different phlebotomist - I'd recommend the latter choice if at all possible.

Answer 4

One thing that causes phlebotomists to comply is if you tell them that you might pass out with the larger needle, but with the smaller needle you never pass out.

Patients who pass out when they get blood drawn--and it happens more than you might think (see vasovagal syncope response)--are the phlebotomists greatest fear. So, they'll gladly do anything to avoid a patient passing out.

Word will quickly spread that you require the smaller needle.

Answer 5

I would agree with most of the suggestions above but ultimately its up to you what happens. They are providing a service to you - not vice versa. If you know what you want/need and you know you aren't being unreasonable then insist upon it. Do not consent to any procedure you don't want. When it comes to your health then offending someone is of secondary importance. Talk to their office manager, or to your doctor and make it clear what you need. Get up and walk out if needed.