Ways to say “No” to your patients and still keep them smiling.

Telling patients no is not always easy.  Primary care physicians (PCPs) know this all too well. Most providers feel pressure to obtain better patient satisfaction scores and know that their compensation, in part, is linked to this.

How do you tell such patients “no” in a nice way that minimizes your risk of being trashed online, receiving a low score on a patient survey, or inciting the patient to switch physicians? Let’s take a look.

Couch a No in an ExplanationTelling a patient, “No, you can’t have that drug, test, study, or appointment,” maximizes the odds that the news will not go over well. There’s a more diplomatic, less confrontational way to achieve the same result.  Instead, try saying, “Okay, we can consider your request, but let me tell you what I recommend that I think will be better for you.”

Open a DiscussionWhen a patient makes a specific request that you’re not willing to accede to, you can diffuse potential conflict by taking a moment to understand the “why” behind the patient’s request.  They likely have something they’re worried about. You have to peel that back.  Ask yourself, “What is it the patient is really seeking?”

Be Willing to NegotiateNegotiating with a patient isn’t the same as, say, a legal negotiation.  Your willingness to engage with the patient makes ultimately going against the patient’s wishes much more palatable than a flat-out no. The patient feels that he or she has been heard by you, which is often what patients want.

Be a CheerleaderTurn a hard no into a soft one by offering positive reinforcement to patients.

Reinforce that what patients are doing is right and that they don’t need more drugs or whatever it is they want.”

Use a Good Cop/Bad Cop Routine Having the nurse or 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.

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.

Match Your Response to the Patient- Your response depends on how well you know the patient and their level of education.

Framing a response to the patient with a view to who the patient is as an individual is important.

Deflect the BlameThere are times when you need to say “no” to a patient that are not solely your decision. But because you’re the only one in the room with the patient, it’s okay to deflect the blame to the absent party to make life easier on yourself.

For example, when a patient asks for an expensive test, you could say, “I can try to get that approved by your insurance, but I know from past experiences, it likely will not happen.”  That way the insurance company is the bad guy, not you.

When Necessary, Be Firm– Most of the time, if you do it diplomatically, patients will take no for an answer. But sometimes they won’t. In those instances, put your foot down—but gently.

At the end of the day, it’s all about letting patients believe. That they’ve at least won some dignity. The flat out “no’” answer takes away their dignity. It takes away their feeling of  self-worth and pride. We need to make them feel as though they still have that when they leave the office.

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