When Doctors Can't Say No to Patients
Since Michael Jackson’s unexpected death, reports have been swirling about his prescription drug abuse and the many doctors who prescribed him narcotic sedatives that are normally only found in hospitals. While his nurses and friends refused to give him narcotics such as Diprivan, his doctors would comply.
In fact, sources close to Jackson told CNN that when the pop star suffered from insomnia during a world tour in the mid 1990s, an anesthesiologist would travel with Jackson and “take him down” at night and “bring him back up” in the morning. Security guards in Jackson’s inner circle told Santa Barbara police in 2004 that Jackson traveled the country getting prescriptions from different doctors.
“Michael’s addiction was ultimately created by doctors,” said Deepak Chopra, a close friend of Jackson’s.
According to a CNN article, experts on doctor behavior say that physicians often find it hard to say no to patients—even when the patient isn’t a celebrity.
"There's constant pressure to say yes to things even when it's not in the patient's best interest," said Dr. Joseph Weiner, chief of consultation psychiatry at North Shore University Hospital in Manhasset, New York. "It's become an everyday dilemma."
Dr. Weiner said that doctors sometimes say yes to requests for antibiotics for the common cold, or will write a prescription for a drug advertised on television even when that drug isn’t the best choice. Sometimes doctors will agree to extensive tests and treatments for patients who are at the end of their life, even when they know death is unavoidable.
Sometimes doctors submit to patients’ requests because of time limitations. “Doctors want to get the patient in and out in five minutes, so it’s much easier to just write the prescription the patient asks for,” said Chopra.
Another doctor said that it could be due to the changing nature of the doctor-patient relationship. "In the current environment in which patients are supposed to be treated like customers, there is sometimes the expectation that the customer is always right and should get whatever is asked for," said Dr. Danielle Ofri, assistant professor of medicine at New York University School of Medicine.
Ofri remembers an instance where she agreed to give a patient a high dose of oxycodone for back pain and then regretted it. When she hesitated, the patient became upset and accused her of not believing that he had back pain. She ultimately wrote the prescription but “walked around with a terrible feeling in (her) stomach” for the rest of the day. “I really wished I’d said no,” she said.
Surprisingly, the patient returned the next day and handed her the prescription, admitting that he’d lied. “I’m very sorry, and I’m not sure what came over me, but I lied and I owe you an apology,” he said. Ofri said she was “stunned, but relieved.”
Doctors have even written articles suggesting ways to tactfully refuse patients’ requests. One such article in the Permanente Journal reads, “We’re often unready to say no to patients when they want a particular prescription or test, even if it id unwarranted.” The article goes on to give advice on the art of saying no.