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August 10, 1984

Should We Learn to Say No?

JAMA. 1984;252(6):782-784. doi:10.1001/jama.1984.03350060026022

My theme for you tonight is, Should we learn to say no?

Every now and then on the "Tonight Show," Johnny Carson plays a game called "I Have the Answer, What Is the Question?" Ed McMahon feeds him an answer; Johnny quips with the question. Tonight, I have an answer for you. The answer is, "In a ten-year period of time, at least 1,210,000 persons in the United States will have died. Over 1,150,000 will have had their lives shortened. Millions more will have been denied useful, productive, and more comfortable lives because medical care had been denied them." When Johnny does it, he is more irreverent than I will be when I say, "What is the question?" The question is, "What happened when American physicians learned to say no to their patients?"

For over 2,000 years, since the time of Hammurabi, Doctors of Medicine have dedicated themselves to a