Helen Salisbury: Learning to say no (BMJ, 18 July 2022)

Summary

Most doctors enter their training with a desire to help people. When a patient asks us for assistance, and what is requested is within our power, we generally say yes. If what they want is not safe or evidence based—another home detox from alcohol, or a drug that is blacklisted in our formulary—we have good reasons for declining. When the main reason for saying no is that we are just too busy, however, it is far harder.

Our ability to say no raises questions of equity and patient safety; as there are not enough GPs to cope with patients’ demands, we need to be careful how we spend our time.

If we want to continue to look after our patients safely, we must also start learning to say no in other spheres, politely pushing back against the transfer of work from hospitals to general practice.