10 Ways to Say No to Patients -- and Still Keep Them Smiling

Neil Chesanow


February 17, 2016

In This Article

Be a Cheerleader

As the saying goes, you get more flies with honey than you do with vinegar. Turn a hard no into a soft one by offering positive reinforcement to patients.

"There are times when you're actually a cheering section," Dr Fox says. "Tell the patient, 'You're really doing a good job. You may not see it that way today, but you've actually come a long way from when this whole thing started, and what you're doing now is absolutely right." Reinforce that what patients are doing is right and that they don't need more drugs or whatever it is they want."

"One of the things we face all the time is the person who absolutely has to be seen right now," Dr Fox points out. "How do you convince them that they don't need to be seen while making them feel as though you're taking them very seriously, when most people feel if you don't want to see them, you don't believe that they're sick? How do you tell the person who wants the appointment today that they don't need you for the third time in a month?"

"My nurse will say to a patient, 'Dr Fox saw you 3 days ago. Chances are, things haven't changed that much since then. If you truly want to be seen today, we can bring you in. But it might be better if...'—and at that point you make them feel good about what they've done; you put a positive spin on it," Dr Fox says. "A lot of times, you can keep them from walking back in the door when it's not necessary."

Use a Good Cop/Bad Cop Routine

Having your nurse or physician assistant tell a patient no on your behalf can be the icebreaker that leaves patients with a positive experience even though their initial request is ultimately denied.

"I sometimes will have the nurse give the absolute no answer, and then I do the good cop/bad cop routine by walking in and doing the negotiation, while the patient still doesn't have the bottom line yet," Dr Fox says.

"Oftentimes the nurse will say to the patient, 'Dr Fox won't give you that drug.' And then the nurse will walk out and say to me, 'Yeah, they're not happy.' I'll walk in and say, 'Well, Carol seems to think that you're not happy because I won't prescribe the medication you requested. What's going on?' Now the conversation is open. It gives me a chance to say, 'Okay, well, this isn't really what you need, but here's what I will give you.' So it's a good cop/bad cop routine, but you still wind up with the same final result."

Show Patients Empathy

Patients go to see the doctor for a variety of emotional and complex reasons. One of them is to be acknowledged, respected, and understood. This is often more important than having their request for a specific medication or test fulfilled.

"If I give a patient my undivided attention, and I sit down in the chair and meet them eye to eye and face to face and I listen, and then I give them my best advice, I think that counts as something," says Dr Mandrola. "It may sound Pollyanna-ish, but I believe it. I believe that if we meet our patients and we listen and have empathy, it works. Sure, I've had a few bad reviews on Vitals.com because I was late or rushed or whatever, but for the most part, listening and having empathy makes a difference in how patients respond to you."

Dr Mandrola not only sees patients with heart rhythm problems, he has heart rhythm problems himself. "One of the things I do is say, 'I've had this,'" he tells patients. "'I know it sucks. But here's what I would try.' I try to acknowledge to patients that I understand that they have this problem. It doesn't work 100% of the time, but in general, I don't usually feel pressured by patients to do things that I don't feel comfortable with."

"Most people are reasonable enough to understand that if you give them the real reason why you're doing things the way you're doing them, they'll grasp the explanation," Dr Fox believes. "It's the process, not the actual final results, in getting what you need to do."

"At the end of the day, it's all about letting patients believe that they've at least won some dignity," Dr Fox says. "The 'no' answer takes away their dignity. It takes away their feeling of self-worth and pride. You need to make them feel as though they still have that when they leave the office."


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