Helen Salisbury: Learning to say no

Most doctors enter their training with a desire to help people. When a patient asks us for assistance, and what is requested is within our power, we generally say yes. If what they want is not safe or evidence based—another home detox from alcohol, or a drug that is blacklisted in our formulary—we have good reasons for declining. When the main reason for saying no is that we are just too busy, however, it is far harder. Where do we draw the line with private referrals for cosmetic procedures or letters for school about the need for swimming goggles?Our ability to say no raises questions of equity and patient safety; as there are not enough GPs to cope with patients’ demands, we need to be careful how we spend our time. We should beware of exacerbating the inverse care law, as patients least able to ask are often the ones…
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