It may surprise patients to hear that a doctor can be highly skilled — yet choose not to proceed with treatment.
One common reason is expectation mismatch.
When a doctor believes that realistic expectations cannot be achieved, proceeding with treatment may risk dissatisfaction, distress, or harm — even if the procedure itself could technically be performed.
Ethical guidance supports declining treatment when it is unlikely to benefit the patient in a meaningful way or when expectations cannot be aligned through discussion¹. Saying “no” in these circumstances is a protective decision, not a rejection.
Good doctors aim to help patients, not simply to provide interventions. This includes recognising when treatment is unlikely to meet a patient’s goals or when outcomes are being judged against unrealistic standards.
Declining a case can be an act of responsibility and care.
References
- General Medical Council. Decision making and consent. GMC; 2020.
- Beauchamp TL, Childress JF. Principles of biomedical ethics. 8th ed. Oxford University Press; 2019.
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