Just Say NO to Certain Patient Requests—And Here’s How

Despite the fact that psychiatrists want to help and accommodate patients’ wishes, not all patients’ requests can or should be fulfilled. There are situations in which patients may request a particular medication or treatment that is not in their best interest, request a letter for a nonclinical reason, or ask for a “favor,” assuming the psychiatrist will agree. If the psychiatrist denies a request, many patients threaten to call the Board of Medicine or post a bad review.

• Provide an Explanation: Psychiatrists can defuse patient anger by knowing when and how to say “no.” Rather than following your immediate instinct to “just say no” to a request for a medication or service that would not be helpful to the patient, take a minute to contemplate the request and then provide an explanation of why the request would not be in the patient’s best interests. Explicitly state your rationale without lengthy explanations (for example, it would not be appropriate medical care, against policy, or even violate professional ethics).

• Gather Information: Another option is gathering information from the patient regarding the particular request. Identify the underlying factors of the request and whether additional information is necessary before you respond with an explanation of why you cannot agree to grant the “favor.”

• Consider Compelling Principles: Compelling principles to consider when responding to patient requests are integrity and protecting the doctor-patient relationship. While denying a patient’s request may feel like it harms the alliance in the moment, allowing the patient to manipulate the psychiatrist into a false position is also harmful to the relationship, according to Opinions of the Ethics Committee on the Principles of Medical Ethics With Annotations Especially Applicable to Psychiatry, 2020 Edition.

• Avoid Feelings of Guilt: Feelings of guilt should never be part of saying no. No one should agree to a request out of guilt or obligation; doing so will likely lead to additional stress and resentment, which would affect the doctor-patient relationship.

• Be Empathetic: Making empathic statements such as “I know this is not what you wanted” or “I can see you are frustrated” acknowledges the patient’s feelings of frustration or powerlessness. Accepting a patient’s negative emotions, rather than minimizing them or trying to fix them, is important. Knowing when and how to say no while preserving the doctor-patient relationship is not always easy, but it is a best practice to reduce risk and well worth the effort. ■

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