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Note: this draft was written a few days ago and then I put away. I wondered whether or not to post it. I decided yes I would, as it is a ‘slow news day” and TBDHSR members who bothered to read it thought the essay shows my vulnerable side. I am not certain if that is a compliment or a critique for the only vulnerable sides that interest them is where to aim the axe.


Today I had to tell a patient ‘no”.  Prior to the 8AM appointment I read the chart notes: X has had years if not decades of anxiety and X has seen nearly a dozen psychiatrists apparently to no lasting benefit. I wondered if I could do any better. I sent out the Zoom invitation; I got no response.  I sent out another – nothing.  Around 820AM I called X who became anxious explaining they had the appointment down for 10AM and no they haven’t received any Zoom invitations. I sent out a third. Around 830AM there was still no response and the appointment was from 8-845AM, so when X called again for help I said alas this was a bust and we will have to reschedule. In the chart I saw X is getting medication from somebody else and in counseling with someone at our place. X became agitated saying their panic/anxiety was sky-high and had to be seen today.  Indirectly X conveyed if X was learning coping tools/different ways of dealing with the anxiety this wasn’t working or being applied for the present situation. X pleaded for me to start the appointment now over the phone (we have a policy all new patients must be ‘seen’). I said no and X went into hysterics. I repeated the plan to reschedule ASAP and hung up.

Physicians find it painful not to help patients more than they can but it is also painful telling patients ‘no’. Doctors are mostly ‘nice’ people, who are not good nor comfortable telling patients what they want or need isn’t going to happen.* Parents feel something similar with their children. Kids are always asking for things which parents must say ‘no’. Children usually up the ante by crying or by throwing a fit or through nagging – hoping to wear down the parent by attrition.  Everyone knows it is important to set limits with kids as giving them whatever they want does them no good but makes them into horrible human beings, who learn being nasty ‘pays off”.  

Saying ‘no’ to a patient seems harder to do nowadays. Back in the bad old days doctors if your doctor told you not to do something you did so without question.  Nowadays patients see their doctors more like waiters who will bring them want they want and if they don’t they will leave a bad tip in the form of a negative Yelp review, usually along the line ‘my doctor doesn’t listen to me”.

I regularly remind myself I cannot help everyone. I am not a bad person nor a bad doctor telling people no. As I’ve aged this is becoming easier to do but I have lots more to go. I try to explain the ‘no’ and what we will do otherwise. This doesn’t always go well of course. It gets down to being comfortable with someone angry/hurt/feeling let down by me.

As for X, X will probably reschedule and be seen sooner than X feared would happen. I might point out the lesson that waiting a week shows her anxiety although uncomfortable is not the end of the world.  I’m pretty certain the previous twelve shrinks tried something similar.

At some point one has to give up the illusion one can fill a black hole and there is no point to cross the event horizon into one  – painful as this feels.


*SIL #3 is an ER physician. She would find this notion absurd as most of her job  is doing just that viz. telling folks coming to the ER they are not getting certain medications or procedures as if they had walked into an all you can eat buffet.

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September 2020

Spo-Reflections 2006-2018