When Yes Can Be No
2004; Lippincott Williams & Wilkins; Volume: 114; Issue: Supplement Linguagem: Inglês
10.1097/00006534-200410001-00085
ISSN1529-4242
Autores ResumoA patient today told me a story worthy of sharing. He was a 55-year-old manager of a railroad company and had a large, itchy keloid of his sternum. It had never been treated, so I injected it with a steroid. During our conversation, he related that many years ago at another job when he had asked for a raise, his boss replied that “what he could give me was so small that it would be an insult and we would never want to do that you.” My patient would have welcomed the insult. The boss’s remark was diabolical but potentially useful in other settings. To a fund raiser or anyone asking you to contribute your time: “The amount of money (or time) I could give this project is so little that it would be an insult to your noble enterprise.” To a patient at follow-up: “Your visit today would have had to be so brief because of my other commitments that it would be unfair to you and to the tradition of medicine to see you at all. Please make another appointment so we can spend at least 2 hours together (a condition that will never be met).” To a reasonable, nonaddicted patient who desires more pain medication when the doctor receives the call on Sunday at the golf course and is about to win the only match in his life: “To give you a small amount of more pain medication would really be futile. Perhaps in another 24 hours your opiate level (the patient is now completely bewildered) will reach a safe range. Please call me tomorrow (Monday) at the office, and I will reassess this very delicate situation.” To a customer in a restaurant who notes that his steak is undercooked: “As the chef here, I cannot in good conscience permit you to eat leather. To serve you another shoe when you are already wearing two of your own would be absurd. Some people in this restaurant (the chef looks warily while whispering) are too unsophisticated to appreciate the subtleties of red meat. I recognize your obvious intelligence, your capacity to be different, and your willingness to enjoy meat of a pristine quality—not cooked as the barbarians once did.” As I was writing this Editorial, I remembered what happened to me at the town hall many years ago when I appealed a projected tax on my house. “The abatement that you would receive, Doctor, would be minimal-tiny-negligible. The tax assessors are well aware that house owners want relief, but relief to be relief must really be relief. That is why we are redoing all our assessments. We must consider your house in the context of every dwelling in this town. To give you a few cents or perhaps even a dollar or two off would be muddying the waters. I am sure that neither of us would want to be so short-sighted.” My protest was predictably futile. A former resident related a variation of this method of saying yes when you really mean no. He applied for privileges at a hospital and the chief of plastic surgery told him that he would back his application, but he felt guilty because he would not want “a young person and his family to starve. If I were like King Solomon, I would divide each patient so that everyone could benefit. For your own good, I hope that you will reconsider to survive and be happy.” The hospital was sufficiently busy to accommodate at least two more plastic surgeons. That resident went elsewhere, flourished, and eventually joined the staff when the chief finished his earthly rotation. In the past, a selfish person was easy to recognize: he or she was outspoken about not doing anything for anybody. Now, we have an elusive form of withholding: because I can do so little to make a difference, I will do nothing at all. One thus empowers oneself to be unempowered, leaving one free to self-indulge. Consider the consequences in our own specialty if we thought that since we could not become a Gillies, why try at all? Or because I cannot write like Ralph Waldo Emerson, why attempt this Editorial? Many readers might reply: why, indeed?
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