the many types and tones of NO.

03/15/2009 at 6:22 AM Leave a comment

I began to think about the times I have to say no and how many different ways I say it. Also how many different intensities I use. No, I am not talking about parenthood, I am talking about the practice of medicine.

No can go from the extreme of  “that’s not going to happen”. As in patients asking me to prescribe their expensive medicine in the name of someone else that is insured. (Fraud anyone?). This is as close to absolute black as I get. to the “no, I don’t agree with that but you could try it since it wouldn’t hurt” that I use when someone wants me to recommend some highly advertised OTC product. In between there is the No, I won’t order the MRI because your neighbor had one. No, I won’t excuse you from Jury duty because you don’t want to go. No, I won’t increase your narcotic medicine because you cant control your intake. Or the much more difficult, No I can’t increase your narcotic medication, not because of misuse but because the dose is so high and increasing so fast that it is a fools errand to keep chasing the pain.

In the normal course of events at most jobs, saying no is not at all that common. Particularly saying no in person alone in a room when the person is pleading for you to say yes.  Add to that the fact that the person is actually your source of income and Voila you have a constant source of stress. Unless of course you develop the skill set to deal with it. As you become better and more accustomed it becomes easier and less draining.

At this point, saying no to miss-prescribing, avoiding jury duty, work notes ( for days I cannot vouch for), do not even penetrate enough to concern me. Saying no to patients that use up their narcotics too quickly is just a bit harder ( because they really have pain). Saying no to those whose pain I cannot control well, that is much harder. Certainly I send them off to pain management, but that has many problems of its own.

DO NOT go into medicine if you cannot say no, or learn to say no frequently and without a huge personal cost. You are the Key maker, the opener of doors, people will come trying to get you to do something you would not ordinarily do. They will be convincing, pathetic, praising, and most certainly manipulative–and some of them will be very, very good at it.

I can’t say no every time. Just like in parenting sometimes you have to pick your battles, but if you cannot say it when necessary life becomes very difficult and you become a victim to the next patient that requests something.

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Entry filed under: Doctor Musings. Tags: , , , .

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