■ Physician-patient:

Communicating effectively with patients to optimize their care

Patient request for form

Published: August 2021

Type of activity: Video

Activity summary

The short video "Patient request for form" portrays a physician's uneasy response to a patient's request to fill out a form. The facilitation questions and suggestions to faculty focus on allowing learners to consider how they would respond to an uncomfortable situation with a patient.


Setting: Family physician office with two characters - Mary Robinson, a patient, and Dr. Pink, a family physician.

Dr. Pink: Ok Mrs. Robinson, that covers it for today. We'll be in touch in a month and we'll follow up on your blood work.

Mary: Thank you doctor. Oh, before you go, I have this form for my disability benefits that I need you to sign today.

Dr. Pink: Really? What disability?

Mary: My migraines. I'm applying for a new desk in an office with no windows and those, you know, those special light bulbs for sensitive people.

Dr. Pink: Really? Well it's been some time since we talked about your headaches. I just have to refresh my memory...

Mary: (interrupting Dr. Pink) No, don't worry. I can tell you all about it.

Dr. Pink: Well, no, it's not that... I just have to look at my files to refresh...

Mary: Really, I have already filled out most of the form. All you have to do is fill in that little bit down there.

Dr. Pink: What, here? "Indicate the date of initial diagnosis and the name of the diagnosing physician..."?

Mary: Dr. James, yes I saw him, but, you know, I really don't like him and besides you were seeing me too at the same time. So if you don't mind just putting your name down in there and it'll just keep everything simple.

Dr. Pink: Well, I can't really, I mean, I....

Mary: It's fine, Doctor, really, I mean it's just for work, it's not like the RCMP are going to check it or anything.

Dr. Pink: I'll tell you what, leave it with me and I'll get it back to you in a few days.

Mary: Um, it's due tomorrow, and, uh, I really need it. And, besides it's really hard to get in to see you, so, I need it today please.

Dr. Pink: So, um, you want me to put my name here?

Mary: Right there, please.

Dr. Pink: There's a $60.00 charge for filling out this form. You'll have to pay the receptionist on the way out before you get the form back.

Mary: What? I filled it all out myself!

Concluding facilitation question: What factors led to the physician's decision to sign the form?

Facilitation questions

  1. What factors led to the physician's decision to sign the form?
  2. What patient behaviours contributed to making this situation uncomfortable for the physician?
  3. What suggestions do you have for a physician in this situation, to ensure the patient is treated both fairly and professionally?

Suggestions to faculty

In this video, the physician signs a form without fully consulting the patient's medical record. To better understand third-party reports, have learners complete the following CMPA eLearning activity: Medical letters, forms and reports.

CanMEDS: Communicator, Professional

DISCLAIMER: The information contained in this learning material is for general educational purposes only and is not intended to provide specific professional medical or legal advice, nor to constitute a "standard of care" for Canadian healthcare professionals. The use of CMPA learning resources is subject to the foregoing as well as the CMPA's Terms of Use.