You’re eight minutes into your SCA case. Mr Smith is pushing hard for a scan.
You know it’s not indicated.
But bluntly saying “no” can backfire.
He’s anxious. Frustrated. Maybe even a little fearful.
You don’t want to dismiss him but you can’t just cave either.
Sound familiar?
Saying “no” in a consultation is one of the hardest skills to get right, especially when the patient is adamant or worried. But in the SCA (and real-life general practice), how you say no can make or break the entire consultation.
The key? Do it with HEART.
Let me show you how.
Hear with Intention
Before you even think about explaining why an MRI isn’t needed… pause.
Let the patient speak. Not just to hear their words, but to understand their worry.
You might say:
“I can see that you’re really concerned about these symptoms. Tell me more about what’s been going through your mind.”
That one sentence can shift the whole energy in the room.
Why? Because when people feel heard, they stop pushing. They lean in. They listen.
And so will your examiner.
Educate with Clarity
Now’s the time to step in with your clinical expertise — but not in a “you’re wrong and I’m right” kind of way.
Think calm clarity. No jargon. No lectures.
You might say:
“I understand why an MRI might sound reassuring. But in this case, it’s unlikely to give us useful answers.”
This isn’t about saying no — it’s about helping the patient understand why.
Offer Alternative
A flat “no” leaves people feeling shut down. But a “no” followed by a helpful plan? That’s a win.
You might say:
“The good news is that we can support your recovery. Rest, fluids and some simple pain relief are proven to help in cases like this.”
Suddenly, the patient doesn’t feel dismissed. They feel looked after.
And that’s exactly what SCA examiners are looking for: safe practice with compassion.
Reach Agreement
This is your consultation’s pivot point.
You’ve explained the problem. Now build the solution together.
You might say:
“Let’s agree on a plan for the next few days. If things aren’t improving by next week, I’ll see you again and we can review things together.”
When you genuinely involve patients in the decision, they feel respected and they’re more likely to stick to the plan.
Build Trust & Plan Follow-Up
Now seal the deal.
Firm, kind boundaries and clear follow-up build trust.
You might say:
“I don’t think an MRI is needed right now. But let’s touch base in a week to see how things are going. If the pain gets worse before then, please get in touch.”
This shows the examiner you’re not just managing the clinical problem — you’re managing the relationship.
That’s gold in the SCA.
Final Thought
Saying “no” with empathy, clarity and confidence will set you apart.
The HEART method helps you stay calm under pressure, communicate boundaries without conflict and show the SCA examiners you’re a GP who leads with both head and heart.
So next time you feel that surge of panic when a patient makes an unreasonable request…
Take a breath.
Choose HEART.
And handle it like the doctor you’re becoming.
Are You Ready to Unlock Your Career
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