The Option of Saying “NO”

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Several months ago I wrote about the tendency of big-hearted advocates to over-extend themselves with volunteer work; that when someone needs their help, but doesn’t have the means to pay them, they don’t know how to say “no.” We looked at some of the ways to get past that inability in order to keep our businesses moving forward.

Truth is, that is only one of the circumstances where “no” is the right answer.  That’s true whether it is us, as professional advocacy business owners who must choose to say no, or whether we must help our clients choose “no” if it is possibly the right answer for them.

The business “no” is not unusual and will seem very simple once you understand it.

But the client “no” is often overlooked – and you truly owe it to your clients to not only understand it, but to help them understand, and sometimes embrace it, too.

Here’s a business “no” example:

A potential client calls you and asks for your help.  After some screening, you determine that yes, he can afford to pay you, but you realize that what he is asking you to do is outside your current capabilities – you are a hospital bedside advocate and he’s asking you to review his medical bills. For the first time since you started your advocacy business, you have a full roster of clients, so it’s not like you have time to learn the skills needed to help him.  Further, you have little interest in moving into the medical bill reviewing area of advocacy.

You have three choices:  you can say “yes” – and try to learn the medical billing skills you’ll need  (not a good choice!) OR – you can tell him you don’t handle medical billing, but you’ll refer him to someone who can help him.  OR – you can tell him NO.  You’re sorry, but that is not a service you provide.

Choice #2 or #3 are both your best answers.  They are both ways of saying NO.  Choice #2 is actually the best, because referrals among advocacy colleagues (even among coopetition) are best for all advocates.

Here’s a client “no” example:

Your client, a 75-year-old woman with heart disease, has been diagnosed with cancer, a cancer for which there are few options, and all of those options are difficult or debilitating.  When she comes home from meeting with her oncologist, she has already been scheduled for a PICC line and chemo.

You visit your client and she shows you a raft of brochures and paperwork provided by the oncologist.  You try to pull information from her about what she has already been told about her options. You ask her whether they are accommodating for her heart medicine and her pacemaker, and she doesn’t remember whether that was discussed.  She is upset, confused, and overwhelmed. Clearly she is in no position to be making choices because she doesn’t clearly understand all her options. Instead she is buffeted by the system, not really making choices – just going along with what they tell her to do.

Then you ask her if she knows that among her choices is the right to refuse any of this treatment they have scheduled her for.  THAT gets her attention.  Because, in fact, she does have a right to say “no” to any form of treatment.

Most patients don’t realize they have the right to say “no.”  Most never consider it because they are practically railroaded into expensive, and sometimes invasive treatments that are more about the provider or facility making money, and less about helping the patient.  Further, they are so intimidated by the professionals and the process, that they can’t think clearly enough to even wonder if its a possibility.

Obviously, saying “no” to treatment, or tests or procedures, is not a decision you can make for a client – not for a moment.  But you do owe it to your clients to make sure they understand it’s an option they may choose for themselves.  Further, you may be able to help them make the choice through studies where the results have shown that prognosis/life expectancy is almost the same amount of time whether the patient receives treatment, or not.

We, as advocates, cannot be the ones who make that judgment for our clients.  And because we can’t make the judgment under any circumstance, we need to present the possibility for every circumstance.  I can imagine that in many cases, a client would simply laugh it off – which simply means you’ve created a sense of comic relief!

But there will be circumstances when it becomes, first, food for thought, and later, an ongoing, a viable choice.  There will be some clients who find great solace and relief just knowing it’s an option.

Teach them about “no” and not only will they be very grateful, but you will have truly done your job in the best way it can be done.

• • • • • • LEARN MORE • • • • • •
| FOR PATIENTS | FOR ADVOCATES |
A Patient Advocate Is Just Like….
YOMs – and That Sense of Entitlement

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Comments

  1. Tammy Porter  August 15, 2011

    Thank you, Trish, for the reminder that it’s not only okay to say ‘No’, but may be the most appropriate answer for the client as well.

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