How Canadian family doctors can say no without upsetting patients

I am the worst at saying no. My three sons always came to me when they were kids because I was the easy parent. I just hate confrontation.But over the years, I have taught myself how to say no and set boundaries with my patients and co-workers.Rent a spine I lucked into my secretary Michelle who is so good at setting boundaries that a multi-millionaire patient said to me that he would love to hire her because she can “set boundaries without me even knowing it.”All our patients love her, with hardly any complaints in 30 years. She is firm but kind. She protects me from unreasonable requests but still helps the patients.For example, a patient recently called her and said he needed two months off for stress. Michelle told him, “Dr. Crosby usually will only give two weeks and not as a holiday. Dr. Crosby thinks work is therapy. You will have to work hard on fixing your stress with counseling, exercise, proper nutrition.”When I saw the patient, he was already much more in the mindset of going back to work early and I didn’t have to fight with him.Just say noDon’t explain why. The asker will then try to manipulate you into saying yes. I had one young family physician from northern Quebec at a talk of mine at a Toronto national conference. She was asked by a local women’s group to join them for lunch meetings on Thursdays. But she didn’t want to go and said she had a meeting that day. They offered to change to Tuesdays just for her.She should have just said no because anything past that gives the asker a negotiating lever.Explain whyIn some situations, it my be beneficial to explain why. I once was driving home from London, Ont. to Cambridge, Ont. in a blizzard after visiting my 98-year-old mom. I got a call on my speaker phone from a nurse at my nursing home. I informed her I was not on call and she said, “Oh come on Dr. C, this is a quick question.” I told her to call the on-call doctor.I later said to her, “I know you think I am being difficult, but the reason I am still loving my job after 50 years is because I have always set boundaries and cherished my time off. If I had of helped you, you would have done it again. I have 1,400 patients all with problems 24/7/365. I would never be off; I would burn out and quit.”She not only did not do it again but told all her co-workers. I was polite but firm.Use technology to your advantageI constantly get routine calls from the pharmacists at one of my nursing homes at lunch hour. I just don’t pick up and they leave a voicemail and I call them at 1:30 pm. This gives me peace for one and a half hours a day and a chance to recharge my empathy batteries.Be honest with your patientsFor instance, I tell them I don’t believe in narcotics for chronic pain as they don’t help and cause a second problem. I refer them to pain clinics and do everything else I can for them. I even bring in the spouse and we work on it as a team.When it comes to taking away driver’s licenses. I hate this as the patient hates you forever. I try to get a specialist to do it as they never have to see the patient again whereas as the family doctor we are locked in like in a bad marriage. For disability forms, I bring in the patient and we fill them out together so if the patient fails to qualify, they know why. For example, with the disability tax credit, one of the questions asks the patient if they can walk a block. I’ll ask them, “Did you walk a block to get to my office? I tell them that I can only describe their functioning, the government decides if they qualify.Saying no to inappropriate antibioticsWith a viral upper respiratory infection, I’ll do a history and physical and then say, ‘Wow are you ever lucky.” They ask why and I say, “You have a virus. As you know, they don’t respond to antibiotics, which can kill you if you are allergic to them.”Also, they can cause mouth ulcers, rashes and diarrhea. For women, they can even lead to vaginal yeast infections.If they still insist, I’ll typically do a throat culture.MeetingsI try to only get meetings scheduled between 8 and 9 a.m. or 12 and 1 p.m. with meals.Now that I am 76, I only go to the ones that interest me or that I can usefully contribute to. If I have to go to a nursing home one as medical director, I sit and think of the money I am making listening to the report on boilers.Another nice thing about getting old is that I can say in my crotchety old voice, “Let’s start on time and end early and reward the people who are here.”How do you say no (or not)? Comment below or mail me at drjohncrosby@rogers.com.

How Canadian family doctors can say no without upsetting patients

Register for free access or login.

More Blog Posts In This Series

My predictions for 2026

Tales of emergency rooms past

Why this rural family medicine resident loves his job

Blog Author

JohnWyatt Crosby

Related Topics