How to Say No to Patients, Ethically

It is also important to be cognizant that the patient might be concerned about other issues, such as the presence of a tumor or malignancy, and open-ended questions might elicit such concerns. The otolaryngologist should provide a cogent explanation for denying the antibiotic request so that the patient does not feel ignored.

The other requests regarding filling her general medical prescriptions are normally not a part of the services of an otolaryngologist, but rather of a primary care physician. The responsibility for prescribing medications such as statins, diabetic medications, and thyroid drugs is typically not a part of an otolaryngologist’s practice. It is better to politely decline to do so, explaining the different responsibilities of the specialist versus primary care, and offering to arrange for the patient to be seen by a primary care physician as soon as feasible. The otolaryngologist should be understanding of the patient’s dilemma, but also firm about not prescribing those medications for patients who require the care of a generalist physician.

“Saying no” to a patient does not mean that the patient–physician relationship will become negative or counterproductive. It depends upon how the otolaryngologist conveys the information to the patient and works to help the patient understand the situation. If the patient feels the otolaryngologist is honest and has her best interests in mind, as well as having presented a plan for further evaluation and monitoring of her ear pain and a referral to a primary care physician, it is likely she will become a valued patient. In this particular situation, non-maleficence outweighs patient self-determination (autonomy), and the end result will likely be beneficial for the patient—and for the otolaryngologist.

Dr. Holt is professor emeritus in the department of otolaryngology–head and neck surgery at the University of Texas Health Science Center in San Antonio.