Gary McClain, PhD, is a therapist, patient advocate, and writer who specializes in helping clients—as well as their family members and professional caregivers—deal with the emotional impact of chronic and life-threatening illnesses.
Laura and her doctor work well together. So well, that she often jokes with him that they can almost finish each other’s sentences. She looks forward to her appointments with him. Over the 15 years that she has been his patient, she has learned about his wife and children, even met them, and Laura has referred her husband and many of her friends to him.
During the last month or so, Laura has had some pain that, while it comes and goes, is nonetheless annoying. She looked it up on a medical website and learned that it can be a symptom of a serious condition, which alarmed her. The information she read discussed a new test that has become available which is now being used to diagnose patients with this condition. Laura did some additional research on the test, and then made an appointment with her doctor.
Laura and her doctor started off by briefly catching up on each other’s lives. Laura then described her symptoms. She expected her doctor to offer to schedule testing right away. When he didn’t, she told him that she wanted to be tested and the name of the test.
“Yes, I am aware of that test,” her doctor responded. “But you don’t have the symptoms that would indicate to need it. It’s also a very expensive test. Let’s hold off for now and see how you feel over the next month. In the meantime, there is an over-the-counter remedy that you can try.”
Laura was taken by surprise. She didn’t remember her doctor ever saying no to her before. She wasn’t sure how to react, so she nodded her head in agreement, and her doctor went on to his next patient.
That evening, Laura realized that she felt really disappointed by her doctor’s decision. She felt like he didn’t understand how concerned she was about her symptoms. Wouldn’t it make sense to schedule the test just to make sure she was okay? That seemed logical to her. Laura had to ask herself if he was as concerned about her wellbeing as she thought he was, or if he even cared about her.
Hearing 'no' from your doctor
Has your doctor ever refused your request for a medication or a medical test?
Let’s face it. Nobody likes to hear the word "no." Especially from someone whose relationship you value, and who has in the past listened to you and respected your opinion. So when your doctor acts like a gatekeeper, and says no, it’s hard not to feel discounted, and possibly ask yourself: “What’s going on here? Doesn’t my doctor care how concerned I am about this?”
But here’s something to consider: Are there times when being handed a page or two from your doctor’s prescription pad feels like you are being acknowledged and cared for? Respected? Loved?
And if so, how about considering an alternate perspective: Could a “no” from your doctor be a “yes” to your wellness (as well as your wallet)?
Changing your perspective on care
How about considering a shift in perspective or a conversation with your doctor that doesn’t leave you feeling disempowered? Here’s how to get started:
Ask yourself: Am I taking this personally when it isn’t? When you have a good relationship with your doctor, it is only human nature to expect that when you ask for something, your doctor will say yes. Especially when he/she has in the past. So that "no" can feel very personal, as if your doctor doesn’t trust or want your input after all. Or you may feel that your doctor isn’t as concerned about your welfare as you thought.
Consider that a "no" to a request is a "yes" to your best interests. Your doctor may have been exposed to information about a test you are not aware of, or had experiences with other patients, and concluded the test is not necessary in your case. A doctor who is acting in the best interest of the patient knows when and how to say no. And being a team member with your doctor doesn’t always mean the two of you have to agree.
Ask yourself where you hurt the most. Sure, nobody likes to be sick. And the media constantly give us reasons why we might have something wrong, along with tests and medications to ask our doctors about. Sometimes you just have to wonder if the symptom was there before you were warned it might be on its way. Be aware of how you’re feeling, when you noticed your symptoms, if you have felt this way in the past, and, if so , how it was resolved. Is it time to check in with the doctor? Or would it make sense to focus on taking better care of yourself and waiting to see if anything changes? You know your own body. You know when something may not be right. Give yourself a chance to listen before you make a move.
And when you make that appointment, make it with an open mind. It’s hard not to have specific expectations regarding what you want your doctor to do for you, based on what you think you know about any symptoms you might be experiencing. Meet with your doctor with the intention of learning and collaborating, not with the idea of following a specific agenda. You can avoid stress and unnecessary treatment by reminding yourself there are any number of reasons why you may be feeling this way.
Now, here are some ideas for communicating with your doctor when you are concerned he/she isn’t recommending a medication or a test you think you need:
Take a step back and breathe. A "no" from your doctor can leaving you feeling like you just had the wind knocked out of your sails. It may also seem annoying, and a little scary if you feel your medical issue is being overlooked. But your initial reaction will soon be followed by reasoning. So, pause before you react. Take a moment to consider that your doctor has a perspective here and, until you have more information, it’s not yet time to draw conclusions. Tell yourself: “This wasn’t what I expected. Let’s not make any assumptions until I understand what the doctor’s thinking.”
Acknowledge that you respect your doctor’s opinion. If you have established a relationship with your doctor over time, you have most likely learned to respect his/her opinion. Or if you are meeting with a new doctor, chances are you have chosen that doctor because of training and experience. Acknowledging your respect can get the conversation started on a positive note and help to avoid any combativeness that might arise. Something like: “We have worked together for a long time" or, "I have heard/read good things about you and I know you have a lot of knowledge in this area.”
Explain the reason for your request. If you haven’t already, briefly explain to your doctor why you want this test or medication. Hopefully, you have some data or information here to back up your request, including what you know about it and why you think you would benefit. You might try: “I am asking for this medication/test because I read in (name of publication/website) that ______ .” You might want to bring a few notes with you, as well as a printout of what you read to show your doctor.
Ask your doctor to explain his/her reasoning. Just a simple request will do. “Do you mind letting me know why you don’t want to give me this medication/schedule this test?”
Now, listen. It’s your turn to gain a better understanding of your doctor’s reasons for refusing your request. Whether or not your doctor was willing to listen to why you made this request, your question will most likely result in learning more about his/her perspective. Try to listen with an open mind, and with the assumption that your doctor wants to treat you to the best of his or her ability. Remind yourself that your doctor’s refusal does not mean that he or she is any less concerned about your wellbeing. In fact, it may mean the opposite.
If you aren’t convinced, explore the alternatives. You may feel satisfied with your doctor’s answer, or you may not be satisfied. You have some options here. If your doctor refused a medication, you might ask what alternatives he/she might suggest to treat your symptoms, or if any treatment at all is needed: “Is there anything else I can do about these symptoms?” If your doctor refused a test, you might ask your doctor if there is anything you should be watching for in the future. “Is there a point where you might recommend that I be tested? And if so, what should I be watching for?”
Your doctor is a professional first, not a friend
Laura decided to take her doctor’s advice and do her own “watchful waiting,” and to try the remedy he suggested. She returned a few weeks later to meet with him for a regularly scheduled appointment. And this time, she had the goal of sharing information with her doctor and collaborating on a solution. He explained to Laura that she did not have the major symptoms associated with the chronic condition she had feared. And the test she had requested would have required loss of day’s work as well as required a large copay. She felt relieved that her doctor hadn’t scheduled it.
Here’s the broader lesson that Laura learned from this experience:
Take a look at your expectations for the relationship with your doctor. We enjoy being with people who care about us, who listen, and who respond. And let’s face it, there are never enough of those people in our lives. When a professional relationship has developed and deepened over time, it’s only human to feel like it is a friendship. Your doctor shows his or her concern by listening, and by responding with prescriptions and with tests. And so we develop expectations, and those prescriptions and tests can feel like signs that your doctor cares.
Your doctor is a professional but not your best friend. Professional relationships are built on trust, and honesty. And for a medical professional, professionalism means using resources judiciously, when they are needed, but not when in the physician’s judgment, they are not needed. You, in turn, are empowered to accept your doctor’s recommendation or not, and to choose to get a second opinion.