First I think I should explain what I mean by ‘No’
When I say ‘no’ I mean ‘No I will not’, rather than ‘no I don’t think you should’.
I would say NO to a patient who came to me wanting treatment, but they were not safe to treat.
What do I mean by this? I mean that I can’t come up with a diganosis, or that treatment would delay an accurate diagnosis. In these situations they may need referral for accurate diagnosis. Say I suspect someone might have a sinister condition – like cancer – or I simply can’t be certain from the history, questions and examination what is going on. I can’t know for sure, and though everyone has something mechanical that could possibly be treated, alleviating a certain pain may make that person less likely to follow my advice to get referral back to (or through) their GP. In this case, I have to decline treating someone. This doesn’t mean people with those kinds of conditions can’t get my help – but it is really important to get a diagnosis right.
Usually, people are grateful, but there has been the odd occasion where someone has been upset I wouldn’t treat them. Though I enjoy good rapport with people, I am not here to be a ‘yes’ person, but to be a clinician looking after my patient’s best interests.
Sometimes, that means sending them to someone else.
Someone wants me to do a neck manipulation, when I don’t think it is safe or appropriate for them.
I do very little neck ‘cracking’. The risk of something going wrong is small – but the consequences are large. By risk I mean a ‘cardiovascular accident’ such as a stroke.
- Yes – people more often have them when looking over their shoulder while driving.
- Yes – people more often have them while getting their hair washed in a basin at a hair dressers.
- Yes – the risk of something going wrong in my clinic is low.
But I am held to a higher standard than an untrained person looking over their shoulder and living their life on a daily basis, or a hairwasher or a massage therapist who took a day session learning how to do it.
There are less risky ways of working with necks, and I prefer to choose those methods. People come to me now for exactly that reason. They also have the benefit of knowing I’m not going to ‘sneak up’ on them and crack their neck (which an entirely separate conversation about consent!)
Mainly the reasons I say ‘No’ to patients surround issues of patient safety and patient care. They are the most critical reasons.
But sometimes…only once or twice in many years…someone asks me to do something that ‘just doesn’t fly’ ethically. By this I mean things like date invoices differently so they can submit for an insurance deadline which doesn’t match up with their actual appointment…or to come round to theirs to see their new ceiling fan. OK so those aren’t real examples, however, professional ethics are hugely important to maintain the integrity of not only the profession…but mine as a person.
If someone asks me something under their breath so nobody else can hear (in our empty treatment room) – the answer is likely to be ‘no’!