Australian Doctor Australian Doctor 3rd November 2017 | Page 13

Smart Practice
Tech Talk
Antony Scholefield
Slip, Slop, Slap!
in a digital age
The art of saying ‘no’
MEDICOLEGAL
Having difficulty refusing patient requests?
Stick to the code.
T
HE doctor on the other end of the
phone says, “But, what if the patient
insists?” It’s a common response when
we suggest a doctor says ‘no’ to a
patient.
Doctors face various patient requests every
day. These may include asking the doctor to pre-
scribe a drug, administer a substance, provide a
certificate or sign a form. No matter the request,
a doctor should always be mindful of their clini-
cal, ethical and legal responsibilities, and that
their overarching responsibility is always to act
in the best interests of the patient. In some cir-
cumstances, this will mean saying ‘no’. Whether
or not the patient is satisfied with the response
sometimes depends on the way the patient’s
request is denied.
Your ethical duty
The fundamental basis of ethical conduct and
good patient care is outlined in the Medical
Board of Australia’s Code of Conduct. The code
often guides the way a doctor’s conduct will be
judged if there is a complaint to a disciplinary
body.
Section 5 of the code, for example, emphasises
that good medical practice involves ensuring the
services you provide are necessary and likely to
benefit the patient. Section 2 outlines aspects of
good patient care, including working within the
limits of your competence and scope of practice,
considering the balance of benefit and harm in
all clinical management situations, and those
situations where the care of a patient should be
handed over to someone else.
These provisions reinforce the duty to always
act in the best interests of the patient, and sup-
port GPs in being able to refer a patient on or
facilitate their care to be provided through a
colleague. This might arise where you are not
comfortable with a patient’s request for certain
treatment or where it is outside the scope of your
own skill and expertise.
The code also recognises there are times when
your own beliefs allow you to decline to be

RUANNE BRELL AND DR WALID JAMMAL
TOP TIPS ON SAYING NO
THERE are many situations that require you to say no to a patient. In doing so, however, it is important
to maintain your professionalism, and to do it in an empathic and patient-centred way. This means that
the language used and the reasons will differ and depend on the circumstances.
Focusing on your concern for the patient and on what you can provide may be helpful. And if you do
need to say no, explain the reasons. Here are some examples:
• “I don’t know much about this medication, so I will have to look it up so that we can discuss it together
again later.”
• “I think that this medication will not be useful and could cause you harm. I strongly s