Physicians sometimes have to say no to patient requests. Often, the “No” with an explanation suffices. The patient gets it. They understand. They’re not angry. In fact, they may be appreciative.
But not always.
Sometimes “No” is followed by denial, anger, bargaining, depression, etc. Sound familiar?
How one says “No” matters as much as what is said.
An angry patient may go ballistic on the internet. They may file a complaint to the Board of Medicine. Or file a lawsuit in small claims court.
One useful strategy is to substitute the phrase “No, because…” with “Yes, if…”
You are not saying “No, no matter what.” You are qualifying what it might take to get to a yes, even if that yes is a heavy – or almost impossible – lift.
Let’s illustrate.
Say you are an aesthetic surgeon. The patient has a cosmetic issue well within your skill set to resolve. But they reveal they have a strong psychiatric history. Or they have recent life stressors that make near-term surgery unwise. Instead of saying “No surgery for you because you have a psychiatric history”, you might try this. “Surgery can cause a number of new stresses. I’m willing to perform the surgery if you are cleared by your treating psychiatrist/psychologist. I’ll need to be authorized to speak with your psychiatrist/psychologist. Does that seem reasonable?”
You’ve committed to nothing. And you may soon get an ally to solve the underlying dilemma.
A soft no.
Another example.
“Doc, I’m ready for surgery.” You may be less than enthused to perform surgery on this person.
“Sounds good. My surgical schedule is filled for this procedure for the next 6 months. If you’d like to be evaluated and treated sooner, I can recommend X, Y, or Z. That way you won’t have to wait or be exposed to new pricing.”
Kicking the can down the road may, of course, create a new problem in 6 months. But it may buy sufficient time for the problem to go elsewhere or dissipate.
Anyway, pay attention to language – and the different feelings evoked by “No, because” versus “Yes, if.” As Maya Angelou once wrote, “I’ve learned that people will forget what you said, people will forget what you did, but people will never forget how you made them feel.”
What do you think?
