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Doctors Have Many Ways to Say 'No'
Date:2/22/2010

ome physicians get stuck in their old ways," she said. "This offers physicians a variety of ways to talk to different patients and say no to requests that physicians might believe to be inappropriate to their care. Also, patients are much more satisfied with physicians who act in a way that pays attention to the situation that is driving the request."

It's not known if the antidepressant study can be generalized to other requests, "but at least our study presents a potential hypothesis to be considered," Paterniti said.

"Saying no is a fascinating issue, and what they highlight is exactly on target," said Dr. Charles E. Schwartz, an associate professor of psychiatry, family medicine and medicine at Albert Einstein College of Medicine and an attending physician at Montefiore Medical Center, whose duties include training new doctors in communication skills and working with patients.

"What we find in dealing with patients is that even if you disagree, you have to start where the other individual is starting," Schwartz said. "If you meet them where they are, you might be able to lead them somewhere else."

A request for an antidepressant must be handled with care, because it raises the delicate issue of possible mental illness, he said. But in any case, "people come in with ideas, thoughts and concerns about what is wrong with them and how to deal with them," Schwartz said. "Asking them what their belief system is, what they think is wrong -- those are the key questions to ask patients."

All the strategies described in the study were "patient-centered, or as I conceptualize it, starting where the patient is," Schwartz said. "All are extremely well thought-out, patient-friendly and strategic."

More information

A guide to antidepressants is offered by the U.S. National Library of Medicine.

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