Lesson 2.4 — When the Patient Says No
A refusal is not a failure of the consultation. It is an invitation to understand the patient’s reasoning, check capacity and safety where relevant, explain your concern, negotiate alternatives and respect autonomy.
Explore → Understand → Explain → Negotiate → Respect → Safety-net
Case 6 — “I don’t want statins”
A 58-year-old woman is offered a statin after cardiovascular risk assessment.
“My friend started those tablets and had terrible muscle pains. I’m not taking them.”
“But the benefits outweigh the risks.”
“It sounds like what happened to your friend has made you very wary. What worries you most about taking one yourself?”
You understand the barrier before giving information. That makes later discussion relevant rather than argumentative.
“Would it be okay if we go through the likely benefits, possible side effects and what we could do if you developed symptoms, then you can decide how you feel about it?”
If the Patient Still Declines
- Acknowledge the decision without punishment or judgement.
- Make sure the patient understands material risks and alternatives.
- Offer reasonable follow-up or time to reconsider where appropriate.
- Safety-net clearly.
- Document the discussion in real practice.