This is my column in EM News for the month of January. Sometimes, being a physician means saying no and being disliked. It’s not a popularity contest! It’s about doing the right thing.
Most of us went into medicine because, in addition to being good students, we wanted to help people. How many oceans of ink and forests of paper have been used explaining that point to admissions committees we’ll never know. Suffice it to say, it felt very good when our professors wrote us glowing letters of recommendation. Of course, we were also saying, “I want to feel good about helping people. I want the recognition associated with the act of helping!” Premedical students, medical students, and physicians tend to be those people who desire accolades and who are naturally well-suited to attaining them.
It is deeply moving to hear patients say, “You saved my life.” Or for a parent to say, “My child is alive because you were there.” Those words light up the pleasure centers in our overachieving brains.
It was, therefore, painful for me to finally realize that people sometimes disliked me. In fact, sometimes they despised me! This is the great unspoken reality of the practice of medicine. We won’t always be liked. If you doubt it, walk around Walmart for a few days. Some of your former patients will hug you. Some will snarl at you. That’s life as a medical doctor.
It’s all too easy to suggest that patients won’t like us because we make mistakes. That’s a given but not necessarily the biggest contributor to our being disliked. No one likes when their doctor, or their mechanic, for that matter, makes a mistake. I remember the dentist who gave me a root canal on the wrong tooth. I was a little unhappy, but he had been the family dentist for years so I didn’t really have animosity toward him. I just had a bill and a hole in my tooth. (And not so much as a whiff of nitrous oxide!)
Anyone who analyzes malpractice will report that a physician can make a mistake, sometimes a pretty big one, and patients (and their families) will still forgive them. It’s mostly in the attitude you show toward them, the concern you display, the connection you establish.
Being disliked is not just about mistakes. Being disliked is about humanity and expectations. Humans often expect and desire things they shouldn’t have. Is that judgmental? I hope so. I went to school for a very long time to learn to make judgments and take responsibility for them. Should I be the arbiter of human desires? Maybe not, but as things stand, I have to be.
Here’s the reality. People frequently come to the emergency department because they want pain medication. Human beings have pain, addictions, and an occasional tendency to break the law by selling their medications. Because our government limits access to narcotics, I have to stand in the middle and make decisions about who does or does not receive them. This makes things ugly at times. I won’t be liked when I say no. I don’t even like saying no. I don’t like believing someone might lie to me. But one of my partners recently wrote a prescription for narcotics, and within an hour, the patient was caught, standing outside a pharmacy trying to sell his pills. To avoid that sort of possibility, I have to say no.
I have to say no when someone wants any drug or test that won’t work or may be bad for them. Occasionally I have to say no to CT scans, x-rays, and antibiotics. I try my best to explain my rationale. Usually it works. Sometimes it doesn’t. And bingo! I’m disliked. “Well, I just think I need some x-rays or blood tests.” I understand and respectfully disagree.
I even say no to school and work excuses. Frankly, that bruise shouldn’t limit anyone’s ability to check out groceries. And though my neuroanatomy might be a little rusty, I’m confident that teenaged student’s ankle sprain isn’t directly connected to his frontal lobes, and should not impair learning.
I think in the end saying “no” when “yes” is desired is what makes patient and families dislike us more than anything else we do.
The problem, however, is larger. We live in a culture of yes. We live in a culture of spoiled children of all ages who think that the only answer to any question is a resounding “yes.” Yes to admissions for convenience. Yes to endless care at no cost. Yes to validating non-diseases. The ridiculous parenting attitudes of the past 30 to 40 years translated into a society of adults who throw tantrums when they don’t get what they want, medically, personally, economically, or politically. And once they grow out of stomping their feet and holding their breath, they move on, and fill out angry satisfaction surveys or write scathing evaluations of their doctors or anyone who denies them, in anonymous online forums.
Administrators and academics, also educated and nurtured in the same country at the same time, also eager (as all of us are) to please, make policies that echo this hellish false-construct. If someone is unhappy because they were told no, then the person who told them no is at fault, is cruel, is judgmental, or intolerant, and should be reprimanded, punished, re-educated, or fired.
In our culturally misguided desire to please everyone, we wreck medicine, ruin the lives of patients, and seriously endanger our country with too many narcotics, too many drugs and tests, too many people on disability, and too many doctors (and politicians) struggling to avoid that most terrible of all accusations: “He didn’t give me what I wanted!”
The hard, liberating truth is this: Good doctors do the right thing. In the process, they may make patients unhappy. But if being liked and producing satisfaction on paper is the end-game for this great adventure of medicine, then we are seriously off course, and we can simply throw out all research and focus on the science of pleasure. Medicine can become one great big house of ill repute.
Ironically, if we think there is bias in corporate research or bias in our interactions with pharmaceutical representatives, we should open our eyes to the terrible cultural bias that expects us to answer every request with “yes.” That bias thinks good doctors are never disliked when it may well be that, contrary to popular thought, the best and the brightest are sometimes disliked and are still willing to say “no.”
This is true in all professions. I work at a laundromat and most people at my job do think I’m sweet, kind, friendly, etc.
But I am always a bit amused by the number of people who think freebies are theirs for the asking, no matter how many times they are told ‘No’, who think that rules against sitting on the tables/in the laundry carts don’t apply to them. These people think I’m a rude, mean, #^%$*#^$-type person.
I can live with that. I take it as a sign that I still have good boundaries.
Wow! I’m sure that many members of the teaching profession would agree with this!
Laurie B
14 years ago
Once again, you tell the truth brother Ed.
Peter Clemens
14 years ago
As medical director for a medium sized ED in Western Kentucky, I was just finishing up my post holiday complaints this morning. There was a particularly irritating complaint from a woman who felt it necessary to complain to my administration because one of my physicians ordered a urine pregnancy and would not comply with her demand for a serum test instead. Just picked up your article, wish I could have attached this to the complaint and sent it in as my comments. I may reference this article in the future, it was a little more eloquent than my comment, the… Read more »
Debbie Annett
14 years ago
Edwin, Now that made me smile. Right on! (not to be confused with me smiling because I think you should be a comedian, although you do have a great sense of humour. I agree with other posts that this applies to all jobs/lives. Anytime we “manage/care for/teach/guide” others they will/may dislike us. It applies to child-rearing. Children often “dis-like” their parents when they say “no”. Doing these jobs require love for the being on the receiving end, for they often are not able to properly care for themselves. It is then our jobs to say “no”, but with love, patience… Read more »
wrote a column titled Attention Doctors! People May Not Like You! and if you wonder about the reason for the dislike, Doctor D’s post about Pills and […]
[…] Edwin Leap wrote a column titled Attention Doctors! People May Not Like You! and if you wonder about the reason for the dislike, Doctor D’s post about Pills and […]
Oops…turns out the website does not go inot the comments as an address, but as a highlighted red link to my name. Sorry…still learning the rules of the blogosphere!
Susie W
14 years ago
What about Dennis Sandlin? He is the Kentucky physician shot to death last month while in his clinic. He had refused to give a narcotic script to a patient. So much for saying no. After 23 years of emergency medicine, I am not very inclined to say no very often. Not only does it result in poor patient satisfaction scores and the possible job loss accompanied by low scores, but increasingly we are not safe saying no. I am tired of being threatened by patients who don’t get the controlled substances that they desire. We see an unstable, unpredictable population… Read more »
Good day! This is kind of off topic but I need some advice from an established blog. Is it tough to set up your own blog? I’m not very techincal but I can figure things out pretty quick. I’m thinking about creating my own but I’m not sure where to start. Do you have any tips or suggestions? Appreciate it
Hey there! This is my first comment here so I just wanted to give a quick shout out and say I truly enjoy reading through your posts. Can you recommend any other blogs/websites/forums that cover the same subjects? Thank you so much!
Search engine optimization may appear daunting and then violent unless you get among the a small number of search engine optimization pros. Always keep in mind; it can be a second search engine marketing system having grasping process in need of a few perseverance and then obligation.
Most people usually see themselves on any crossroad at this really is essential since they to be able to consider gaining knowledge from family members or maybe associate and going for various specialized driving lessons. Whilst gaining knowledge through friends is a popular technology, there is a a range of side effects.
Can I just say what a relief to find someone who actually knows what theyre talking about on the internet. You definitely know learn how to deliver an issue to light and make it important. More people need to read this and understand this side of the story. I cant believe youre not more widespread because you definitely have the gift.
I discovered this article while searching through google. Quite extraordinary, since search engines tends to display relatively old results but this one is really recent! Anyway, pretty educational, particularly because this is not something many blogger often write something good about. Take care.
This is the perfect site for anyone who hopes to find out about this topic. You understand so much its almost tough to argue with you (not that I personally would want to…HaHa). You definitely put a brand new spin on a subject that has been discussed for a long time. Great stuff, just excellent!
Another thing I’ve really noticed is for many people, less-than-perfect credit is the result of circumstances over and above their control. Such as they may have been saddled with illness and as a consequence they have excessive bills for collections. It may be due to a job loss or maybe the inability to do the job. Sometimes separation and divorce can really send the financial situation in an opposite direction. Thanks for sharing your thinking on this blog.
Does your blog have a contact page? I’m having problems locating it but, I’d like to send you an email. I’ve got some recommendations for your blog you might be interested in hearing. Either way, great site and I look forward to seeing it develop over time.
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The strategies mentioned in this piece of writing regarding to increase traffic at you own weblog are really fastidious, thanks for such good paragraph.
My programmer is trying to convince me to move to .net from PHP. I have always disliked the idea because of the expenses. But he’s tryiong none the less. I’ve been using WordPress on a number of websites for about a year and am worried about switching to another platform. I have heard very good things about blogengine.net. Is there a way I can import all my wordpress content into it? Any kind of help would be greatly appreciated!
Right now it appears like Movable Type is the top blogging platform out there right now. (from what I’ve read) Is that what you are using on your blog?
Superb blog! Do you have any suggestions for aspiring writers? I’m planning to start my own blog soon but I’m a little lost on everything. Would you propose starting with a free platform like WordPress or go for a paid option? There are so many options out there that I’m completely overwhelmed .. Any suggestions? Thank you!
Thanks for your article. It is unfortunate that over the last ten years, the travel industry has already been able to to tackle terrorism, SARS, tsunamis, flu virus, swine flu, and the first ever real global economic depression. Through everthing the industry has really proven to be solid, resilient plus dynamic, discovering new tips on how to deal with misfortune. There are generally fresh complications and opportunity to which the market must all over again adapt and behave.
Hi just wanted to give you a brief heads up and let you know a few of the pictures aren’t loading properly. I’m not sure why but I think its a linking issue. I’ve tried it in two different browsers and both show the same outcome.
We would also like to say that most people that find themselves devoid of health insurance usually are students, self-employed and people who are laid-off. More than half from the uninsured are really under the age of 35. They do not sense they are wanting health insurance because they are young plus healthy. Its income is usually spent on homes, food, and entertainment. A lot of people that do work either 100 % or part-time are not presented insurance via their jobs so they go without due to the rising expense of health insurance in america. Thanks for the tips… Read more »
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This is true in all professions. I work at a laundromat and most people at my job do think I’m sweet, kind, friendly, etc.
But I am always a bit amused by the number of people who think freebies are theirs for the asking, no matter how many times they are told ‘No’, who think that rules against sitting on the tables/in the laundry carts don’t apply to them. These people think I’m a rude, mean, #^%$*#^$-type person.
I can live with that. I take it as a sign that I still have good boundaries.
Excellent post.
#^%$*#^$-type person.
Wow! I’m sure that many members of the teaching profession would agree with this!
Once again, you tell the truth brother Ed.
As medical director for a medium sized ED in Western Kentucky, I was just finishing up my post holiday complaints this morning. There was a particularly irritating complaint from a woman who felt it necessary to complain to my administration because one of my physicians ordered a urine pregnancy and would not comply with her demand for a serum test instead. Just picked up your article, wish I could have attached this to the complaint and sent it in as my comments. I may reference this article in the future, it was a little more eloquent than my comment, the… Read more »
Edwin, Now that made me smile. Right on! (not to be confused with me smiling because I think you should be a comedian, although you do have a great sense of humour. I agree with other posts that this applies to all jobs/lives. Anytime we “manage/care for/teach/guide” others they will/may dislike us. It applies to child-rearing. Children often “dis-like” their parents when they say “no”. Doing these jobs require love for the being on the receiving end, for they often are not able to properly care for themselves. It is then our jobs to say “no”, but with love, patience… Read more »
wrote a column titled Attention Doctors! People May Not Like You! and if you wonder about the reason for the dislike, Doctor D’s post about Pills and […]
[…] Edwin Leap wrote a column titled Attention Doctors! People May Not Like You! and if you wonder about the reason for the dislike, Doctor D’s post about Pills and […]
Excellent work, as always…actually wrote about some similar thoughts in a “Holiday Wish List” format at my blog site (website above). Enjoyed it!
Oops…turns out the website does not go inot the comments as an address, but as a highlighted red link to my name. Sorry…still learning the rules of the blogosphere!
What about Dennis Sandlin? He is the Kentucky physician shot to death last month while in his clinic. He had refused to give a narcotic script to a patient. So much for saying no. After 23 years of emergency medicine, I am not very inclined to say no very often. Not only does it result in poor patient satisfaction scores and the possible job loss accompanied by low scores, but increasingly we are not safe saying no. I am tired of being threatened by patients who don’t get the controlled substances that they desire. We see an unstable, unpredictable population… Read more »
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Good day! This is kind of off topic but I need some advice from an established blog. Is it tough to set up your own blog? I’m not very techincal but I can figure things out pretty quick. I’m thinking about creating my own but I’m not sure where to start. Do you have any tips or suggestions? Appreciate it
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Hey there! This is my first comment here so I just wanted to give a quick shout out and say I truly enjoy reading through your posts. Can you recommend any other blogs/websites/forums that cover the same subjects? Thank you so much!
Search engine optimization may appear daunting and then violent unless you get among the a small number of search engine optimization pros. Always keep in mind; it can be a second search engine marketing system having grasping process in need of a few perseverance and then obligation.
Most people usually see themselves on any crossroad at this really is essential since they to be able to consider gaining knowledge from family members or maybe associate and going for various specialized driving lessons. Whilst gaining knowledge through friends is a popular technology, there is a a range of side effects.
Can I just say what a relief to find someone who actually knows what theyre talking about on the internet. You definitely know learn how to deliver an issue to light and make it important. More people need to read this and understand this side of the story. I cant believe youre not more widespread because you definitely have the gift.
I discovered this article while searching through google. Quite extraordinary, since search engines tends to display relatively old results but this one is really recent! Anyway, pretty educational, particularly because this is not something many blogger often write something good about. Take care.
good video on electronic? cigarettes reviews and comparisons..this will give information about electronic cigarettes that now widely used.
This is the perfect site for anyone who hopes to find out about this topic. You understand so much its almost tough to argue with you (not that I personally would want to…HaHa). You definitely put a brand new spin on a subject that has been discussed for a long time. Great stuff, just excellent!
Another thing I’ve really noticed is for many people, less-than-perfect credit is the result of circumstances over and above their control. Such as they may have been saddled with illness and as a consequence they have excessive bills for collections. It may be due to a job loss or maybe the inability to do the job. Sometimes separation and divorce can really send the financial situation in an opposite direction. Thanks for sharing your thinking on this blog.
Does your blog have a contact page? I’m having problems locating it but, I’d like to send you an email. I’ve got some recommendations for your blog you might be interested in hearing. Either way, great site and I look forward to seeing it develop over time.
i use google when i want to do some spanish translation, it is good for general spanish translation.,
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The strategies mentioned in this piece of writing regarding to increase traffic at you own weblog are really fastidious, thanks for such good paragraph.
My programmer is trying to convince me to move to .net from PHP. I have always disliked the idea because of the expenses. But he’s tryiong none the less. I’ve been using WordPress on a number of websites for about a year and am worried about switching to another platform. I have heard very good things about blogengine.net. Is there a way I can import all my wordpress content into it? Any kind of help would be greatly appreciated!
Right now it appears like Movable Type is the top blogging platform out there right now. (from what I’ve read) Is that what you are using on your blog?
Superb blog! Do you have any suggestions for aspiring writers? I’m planning to start my own blog soon but I’m a little lost on everything. Would you propose starting with a free platform like WordPress or go for a paid option? There are so many options out there that I’m completely overwhelmed .. Any suggestions? Thank you!
Thanks for your article. It is unfortunate that over the last ten years, the travel industry has already been able to to tackle terrorism, SARS, tsunamis, flu virus, swine flu, and the first ever real global economic depression. Through everthing the industry has really proven to be solid, resilient plus dynamic, discovering new tips on how to deal with misfortune. There are generally fresh complications and opportunity to which the market must all over again adapt and behave.
Hi just wanted to give you a brief heads up and let you know a few of the pictures aren’t loading properly. I’m not sure why but I think its a linking issue. I’ve tried it in two different browsers and both show the same outcome.
We would also like to say that most people that find themselves devoid of health insurance usually are students, self-employed and people who are laid-off. More than half from the uninsured are really under the age of 35. They do not sense they are wanting health insurance because they are young plus healthy. Its income is usually spent on homes, food, and entertainment. A lot of people that do work either 100 % or part-time are not presented insurance via their jobs so they go without due to the rising expense of health insurance in america. Thanks for the tips… Read more »