When Jane* learned she had an uncommon autoimmune condition, her physician recommended a biopsy to confirm the diagnosis and rule out the unlikely, but possible, scenario of cancer. The standard medical treatment for this condition is heavy-duty steroids.

But Jane was uncomfortable using steroids and skipped the biopsy. She found another physician, who suggested Jane try a natural ingredient found in health food stores. After a few weeks, Jane's condition was under control and she happily resumed activities she had reluctantly given up.

Physician Annie Brewster, MD, says the medical term for people like Jane, who deliberately choose not to follow doctors' orders, is non-compliant. And as an MS (multiple sclerosis) patient, Brewster found herself in the same situation when she decided to forgo the aggressive drug therapy recommended by the three neurologists she consulted, none of whom discussed other ways to manage her disease. (Brewster has the mildest form of MS, known as Relapsing/Remitting, and minimal symptoms, she says.)

Both Brewster's and Jane's stories suggest that sometimes it's appropriate to say no to your physician.

More Medicine Doesn't Always Mean Better Medicine

As medicine advances, new diagnostic tests, procedures, and drugs become available. These innovations have the potential to save lives, but they can be overused and may even cause harm. While physicians prefer to avoid risk and often order tests and perform procedures to minimize uncertainty, Elliott Fisher and his colleagues at Dartmouth Medical School estimate that we could eliminate 20 percent of healthcare costs without harming anyone—and perhaps even save lives by preventing complications from unnecessary treatments and hospital stays.

Additionally, our healthcare system tends to reward physicians, especially specialists, for doing more, not less: According to Mark Hyman, MD, specialists hospitalize more patients, write more prescriptions, and order more tests than primary care physicians. So if you're seeing a specialist about a particular health issue, she may be more inclined to recommend a medical intervention.

Finally, patients are also part of the problem. We believe—sometimes incorrectly—that additional tests and new drugs or treatments always mean better quality care.

A Careful Patient's Guide to Informed Non-Compliance

So how should healthcare consumers decide if—or when—they should just say no?

Physician H. Gilbert Welch, MD, author of Should I Be Tested for Cancer? Maybe Not and Here's Why, suggests consumers evaluate their attitudes about medical care along a spectrum, based on their level of comfort with both risk and medical procedures. Ask yourself these questions:

  • Do you want to seek minimal medical care while well, even though it may slightly raise your risk of not catching a problem early?
  • Are you more comfortable pursuing maximum medical care when you're well, thus risking overtreatment?

Medical decisions are difficult, and there is no one "right" answer. Every patient's risk tolerance is different, and individuals must weigh the potential consequences of their decisions.

*not her real name

Liesa Harte, MD, reviewed this article.




Brewster, Annie. "Patient Angst: When You Just Have to Say 'No' to the Doctor." CommonHealth. Web. 31 August 2012. Page accessed 13 August 2013. http://commonhealth.wbur.org/2012/08/patient-angst-when-you-just-have-to-say-no-to-the-doctor

Hyman, Mark. "Should You Fire Your Specialist?" Dr. Mark Hyman. Web. 1 March 2012. Page accessed 13 August 2013. http://drhyman.com/blog/2012/03/01/should-you-fire-your-specialist/

Welch, Gilbert H. Should You Be Tested for Cancer? Maybe Not and Here's Why. Berkeley and Los Angeles: University of California Press, 2004.

Avitzur, Orly. "When it's Time to Fire Your Doctor." Consumer Reports on Health. Web. July 2009. Page accessed 13 August 2013.http://www.consumerreports.org/cro/2012/04/when-it-s-time-to-fire-your-doctor/index.htm

Langreth, Robert. "Good Medicine: When to Say No to Your Doctor." Forbes Magazine. Web. 12 November 2009. Page accessed 13 August 2013.