The art of saying no: Doctors need to learn how

With physicians being pulled in many directions, priorities and time management skills are necessary to maintain productivity without destroying relationships. That takes a delicate approach.

By Mike Norbut, AMNews staff. May 1, 2006.

People always are lobbying for a physician's time, from the patient who brings a long list of questions to an appointment to the practice manager who wants to discuss new office protocols. With all of the requests, it's a wonder a doctor can stay even remotely close to a planned schedule.

Those who can stay on task typically trace their success to saying one thing: No.

While saying no can carry a negative connotation, there's an art to it that can save your productivity while preserving your relationships. When time is money, there has to be a recognition of priorities and a balance between what's immediately in front of you and what's to come down the line, physicians said.

Saying no "is not a skill that you get taught in medical school," said internist and palliative care specialist Gail Gazelle, MD, president of Palliative Care Associates P.C. in Boston and assistant clinical professor at Harvard Medical School. "Demands are enormous and ever-increasing. To get through your day, you have to be able to say no firmly but kindly."

Obviously, emergency situations call for an immediate response. But it's the nonemergency issues that can affect your schedule or force you to make decisions that could appear unpopular to the recipients of your message.

Style points count when you have to say no because you don't want that person -- whether it's a patient, staff member or pharmaceutical sales representative -- to feel alienated by your response. While some doctors might say it's impossible not to alienate people by refusing their request, the consequences of not saying no could be dangerous as well.