Back in residency, I needed my glasses prescription checked and went to see a family friend who was an ophthalmologist. On the opposite end of the scale from me, he was nearing retirement, and we discussed medical practice in general.
One comment he made was that the hardest thing to learn to do in medicine was saying no. He related that, when younger, he used to try and do hospital consults when needed, but as the years had gone by, he gradually faded out of them.
Over time, this has really turned out to be true in many ways. When you first start out, you want to make everyone – both patients and other doctors – happy. You need the work, too. You gladly take whatever hospital consults come your way. You fill out boatloads of forms. You do work-ins for any doctor who asks.
Years go by. As your practice grows, so do your time limitations (both personal and professional). You turn away more hospital work (although it pains you to do it). You only do work-ins for a handful of favored physicians.
Patients are always bringing in forms. I used to do a lot of them. Now, for many (at least those that require me to rate physical capabilities), I just send them back with a note saying that I can’t judge this because of the small size of my practice and to instead see someone who does.
I’ve been doing this since 1998. I’ve been an attending for longer than I was in college, medical school, and residency combined. Now, my hospital work is limited to just my established patients who show up at the hospital next door to me. Work-ins? I still do them, but I can count on both hands the number of doctors I’m willing to do them for.
Saying no – to both doctors and patients – becomes easier with time. But it still hurts a little when turning away a new patient. After all, I got into this business to help people, and it bothers me to say "no" when asked to do so. But there are only so many hours in a day, and now I’d rather give the leftover time to my family.
Dr. Block has a solo neurology private practice in Scottsdale, Ariz.