Saying ‘yes’ may not always mean that your doctor has your back | Expert Opinion

A patient messaged me recently on our patient portal asking for an antibiotic to treat her respiratory symptoms. When we later spoke, her mild congestion, dry cough, and lack of pain or fever suggested a viral illness. Although she was vaccinated, I advised a COVID-19 test to be sure she was not a contagion risk, and recommended supportive measures, such as fluids and cough medicine, rather than an antibiotic.

I explained the risks of antibiotic side effects, and how overprescribing them can create dangerous, resistant strains that are very difficult to treat.

“But doctor, I’ve had this before, and it always improves with antibiotics,” she said, her disappointment clear.

I later learned that, shortly after our conversation, she went to a local urgent-care center and received the prescription she wanted.

Later that same week, a man who had recent hand surgery asked me to renew the opioid pain medicine that his surgeon had prescribed.

“He only gave me a five-day prescription,” the patient said. When he asked his surgeon for a refill, the surgeon told him “no” and recommended something less potent.

“I think he is looking out for your best interest,” I replied. I did not renew the prescription, and we talked about safe opioid use.

Medicine is a helping profession, and I have never met a physician who doesn’t enjoy making patients happy. We endeavor to do this by receiving stories, solving problems, treating or curing illness, and relieving suffering. When done well, however, good medical care does not mean always saying “yes” to patient requests. In fact, as the above examples illustrate, if the answer to everything you ask from your doctor is “yes,” then it may be time to dig a little deeper.

“No” is not something we are used to hearing from people in service industries, of which medicine is certainly one. But medicine has some important differences. While many aspects of a doctor’s visit are easy to evaluate without any specific expertise (such as cleanliness, courtesy of staff), excellent clinical care is complex, nuanced and not as easily evaluated without specific knowledge, training and experience. So how can you tell if “no” is dismissive or good medical judgment?

If “no” is a hard stop, without explanation or discussion, you should be skeptical. Your physician should acknowledge your concern, show curiosity and interest, and seek to understand your perspective. This is often referred to as shared decision making, a collaborative approach to doctor-patient conversations.

“Yes” also merits a thorough explanation, and a quick, uninvolved affirmation should also give you pause. Every patient deserves to feel heard and respected, regardless of the answer to a request.

The quality of medical decision making is best when both doctors and patients come to the conversation with an open mind. If you leave the office feeling as if your worries were addressed and treatments explained with clarity and concern, then you are likely in caring and capable hands.

Jeffrey Millstein is a primary-care physician and medical director for patient experience-regional practices at Penn Medicine. The opinions expressed in this article do not necessarily represent those of the University of Pennsylvania Health System or the Perelman School of Medicine.