First off, ‘no’ is not a four letter word. I recall the grades in Catholic elementary school. One was for obedience. There were many parents incredulous when their errant child came home with an ‘A” as they double checked the name on the report card. They’re often obstinate child seemed perfectly capable of following orders- just not at home! Anyone over fifty recalls when obedience to authority was valued and we feel guilty not complying with the norm. So, let me give you new permission. Saying ‘no’ is not defiant or selfish. In healthcare, decisions must conform with your own values, needs and vision for your life.

As a doc we say “treat” or “get tested” or often we just set you up for this craziness without asking. It’s a “trust me we know what’s best for you” mentality and you may be tempted to fall in line to get the coveted “A”. But treating cancer and all disease should come with life options, not just treatment options. Sure therapies have changed but more remarkably the decisions have too. Patients in the ’90’s would sometimes say, “Whatever you think, Doc”. Now they come with reams of web information. But here is what I find interesting: People are taking control of their therapy, not just with information but by bringing into the plan their own unique perspective and needs.

“Doc if I cannot be cured, I will not use our retirement savings for treatment. My wife has longevity in her family and could live another twenty years. I cannot leave her broke.” Mr. James has a point about consuming resources. Carlos has a great life here in the states and regularly sends money home to Honduras. “I can still work so if you could just help me survive as long as possible, it’s not for me but it’s good for my family”.

Even small issues are on the table: Sandra will not agree to a chemo that causes hair loss before her grandson’s wedding. “Its going to be the last time many of them see me so I have to look spectacular!” Elaine is a quilter and refuses the chemo that causes peripheral neuropathy with numbness in her fingers- she’ll accept the hormone therapy but that’s all. For the many patients I care for, it is not about whether they can survive and “do everything”. Often the decisions are about other aspects of life.

My best advice is very simple: If you or a loved one are diagnosed with an illness, listen to the “gold standard of care” from your physicians, do some research and then weigh the pros and cons of going all in vs no or less therapy.

A Doctor’s dictum is to “Do no harm”. I believe this includes encouraging the patients’ decisions, and avoid forcing our own skill and value system on them. Just because I can treat doesn’t mean that I should. Back up a pace, evaluate what is right for you.

If you have a doctor who is dogmatic “my way or the highway”, find someone who really sees you and accepts your role in the process. We don’t pay for your treatment. We don’t go home and care for your children, or help your parent, or spoon feed you grandmother. We don’t work your job and support your family. We are not attending your events when you want to feel well rather than sick with treatment. There is always risk to letting cancer grow, spread and take over your life. BUT there also is risk to saying ‘yes’ to everything.

Always speak up. Never be afraid. Find therapy that matches your own path and physicians who respect your part in the plan. When you are brave, find those who fight- fight- fight for you. When you are tired express that you are done. Live your own life always. Never be bullied even by well meaning doctors or relatives. You have the right to say ‘no’. Its not selfish its self-care. You will never ever be sorry when you are in control. We are all here for you, but only by choosing your own path can you have peace and your own unique wellness. Obedience to your own internal guide always deserves the “A”.