How to say ‘no’ to patients.


Do you ever find yourself struggling with how to say ‘no’ to a patient?

Pushy patients. We’ve all had them.

If you’ve ever worked in the NHS or if you’re still working in the NHS, you will have frequently had to say ‘no’ to a patient.

Often, there aren’t the resources to get them exactly what they want.

Often, there isn’t sufficient time in an appointment slot, so the patient is told to come back another time. Maybe you really wanted to achieve something for a patient, but it just isn’t in your gift.

Private Practice, however, is different

Patients pay to come and ‘get what they want’ and most of the time, our patients are lovely and have very reasonable requests and expectations.

Had a raging hip pain and a limp for six months? Yep, let’s set up that MRI.

Had profound depression and are struggling to cope? Yep, we’ve got an entire team of therapists and medications to help you with that.

But every now and then, we may meet a patient who has trouble written all over them. And here’s the thing, they know how to spot a kind-hearted clinician when they see one, and therein lies our downfall.


Some Clinicians have absolutely no trouble in telling patients ‘no’, very, very firmly.

Maybe you’re one of these people, but many of us can fall prey of being persuaded by patients, because we’re, well, too nice.

Now, I’m not talking about the kind of patient who quibbles over the price, or who’s mean to your medical secretary, (they need to be firmly tweaked on the nose, and ejected from our clinics).

Nor am I talking about the kind of patient who wants to talk you into doing something you’d consider unethical or frankly, just clinically wrong.

No, I’m talking about the patient who is much more subtle in their approach and much of the time, I don’t even think that they’re doing it consciously.

Let me give you an example:

Let’s imagine that you’re an orthopaedic surgeon who specialises in arthroscopic shoulder surgery. You meet in clinic a patient who seeks you out because they’ve heard from their physio that ‘you’re their best hope’, and so far, no one else has been able to help them.

Said patient has had a steroid injection, a hydrodilation injection, and they’re looking for you to repair their shoulder labrum. Because after all, that’s what she and her physio believed to be the problem.

You assess the patient and examine her; she’s anxious and a little bit prickly.

She moans about how long it takes to get registered at the hospital reception.

And after you’ve seen her and after you’ve examined her, and after you’ve gone through the MRI scan that she’s already acquired herself, you have an earnest chat.

Let’s imagine that the patient had a tonne of good rehab and you deemed from her story and the examination process and imaging, that there was the possibility that surgery to her labrum might, emphasis might, help.

You explain your thought process.

You explain that you didn’t think that it was likely, but that it might help her.

You explain on many, many levels that the surgery might not help solve her pain or improve her function.

You state that it would have a protracted rehab time and as with all surgery, there were associated risks.

The patient nods emphatically and says, “Yes, yes, yes”. She says “I understand all of that, but I really want to go ahead with the surgery because I just can’t live like this.”

Fast forward to the six months post-op stage. She’s still ending a weekly email describing her tale of woe and how she’s “no better” At her followup appointments, she continues to give you the look, (or as my colleague Giles calls it, ‘the stink eye’).

She’s unhappy. Very unhappy. “Why didn’t the surgery work? What are you going to do next to get me better?”.


Saying ‘no’ is equally hard for physios and osteos.

They want a ‘proper’ diagnosis or at least to confirm the diagnosis they have already been given makes sense.

They want to know that the treatment that has been suggested is the ‘best’ or the correct treatment for their particular situation.

If you’re a physio or osteopath, you’re just as likely to fall foul of this kind of patient.

The kind that complains that every rehab exercise hurts them and that they only want to see you for manual hands-on work.

The kind that seeks additional external therapists’ opinions without you’re knowing it, and then asks you to comment on their clinical reasoning.

The kind that makes your heart sink every single time they’re in the diary, and yet they keep on booking in.

The reality is we really can’t help these kinds of patients effectively, and although you may intellectually relish the challenge of figuring them out, or you may even be flattered by their putting their faith in you, the truth is there are some patients we should definitely be saying ‘no’ to.

The crazy thing is, you probably felt it in your gut when you first met them.


Here’s how to say ‘no’.

Remember, as much as you may like helping humans, you are not obliged to have to see or treat any and every patient in Private Practice.

Saying ‘yes’ to the people you should be saying ‘no’ to leads to a stressful time for you, erosion of the moral of your administration staff, and almost certainly not the outcome you’d envisaged for the patient.

Learn to say, instead, “Whilst there’s a chance that this surgery could help you, I’m really not convinced it has a very good likelihood of helping you, and so it would be wrong for me to propose that we operate.”

If you’re a physio or osteo, it’s totally okay to say, “I don’t think I’m able to help you with my treatment any further,” or, “I’m not going to be able to assist you in the way that you want.”


Stand firm and release the patient. Resist being a rebound person for them. If you refer them on, it’s a ‘we’re handed over and we’re done’ situation.
Inevitably, these kind of patients will find someone who gives them what they think they need, but it doesn’t have to be you.


Listen to your gut, and remember to say ‘no’.


Looking for further ways to grow your Private Practice? Check out the Ninja Academy:

See you next time!