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The free-loaders he offers to accompany to the emergency room, if it’s truly that bad. Only one guy took him up on the offer, and it turned out he was in the middle of a heart attack, not a sore throat. “Imagine if I’d seen that person for the sore throat, tossed a few antibiotics on it, and sent him home without a primary doctor to notify. If I was even thinking about wavering before, that reinforced it,” Ramirez says.

Drury says, “It’s not that people won’t get you stuck up against a wall while they talk about their back pain, but most physicians get to be pretty skillful at protecting their space.” Among the smooth lines doctors have developed

over the years:

• “I hear you asking me something that relates to medicine and I’m more than willing to meet with you in my office, but I’m really uncomfortable continuing here. We don’t have a relationship and I don’t have my tools.” Pfifferling likes this approach because it’s clear, direct, and assertive.

• “Here’s my business card, and if you have some concerns, call me during work hours.” Demaria adopted that one after watching the host at a social gathering pull his buddy in the construction business over to look at a door that wasn’t sitting properly in its frame.

• When someone starts spewing information he has found on the Internet, asking for input on various theories, Demaria halts that train in its tracks by asking, “What exactly are you anxious about?” After hearing the answer, he can steer them toward making an appointment during office hours. “Really dig for the real issue—it keeps you from getting lost in the information overload that grips the patient,” he says.

• Ramirez typically ends an awkward conversation with, “As an ER doctor, our relationship technically ended when you left the hospital. Would you like to set up an introductory visit at my private practice office?”

Whatever tack you take to deflect the request, resist apologizing for your stance, Drury says. “You don’t have to go into how badly you feel about it or anything. Just say no, that would be a breach of my responsibilities as a physician.” Period. Even the sports buddy who asked repeatedly in vain for a pain medication prescription didn’t ream Drury out for his refusal, yet fear of rejection usually lies behind why physicians cave in and call the pharmacist in these circumstances.

Of course, physicians who are afraid they’ll be rejected are right sometimes, Pfifferling admits. Friends and family aren’t above pitching a fit and bad-mouthing the uncooperative doctor. “That’s their problem,” he says bluntly. “When most people hear the complaints of upset friends or family members, they know you have clear and defined boundaries, and they respect you even more. The rumors won’t get anywhere, and I’ve watched this many times,” he says. The Ramirez family, for instance, can barely contain the laughter each time a restaurant walk-up slinks away without scoring a prescription. “We just look at each other like, ‘Did they really think that would work?’” he says of the inside joke.

Gazelle, the palliative care physician, on the other hand, doesn’t feel it’s her role to avoid dispensing advice in social situations. If the timing is inappropriate—she’s on a date or busy watching her child at the pool, for example—she will politely explain that it isn’t a good time to concentrate on the question just now. Otherwise, she’s up for a conversation. “If I have information that can help somebody, I should share it because medical information is all too often hoarded by the profession,” she says. She draws the line at writing prescriptions, however, citing literature that proves physicians don’t always use their best judgment when involved in the care of a loved one. She makes sure to use her professional voice rather than slipping into big-sister talk for the conversation.

“I just have to take a mental pause and remember, yes, although this is my parent, they’re calling upon me as a doctor, and I need to frame my responses as I would with any patient,” Gazelle says.

And never give in, Demaria reminds his clients. The first time you make an exception, you open the door to even stronger pressure from the next requestor.

Special favors

Dermatology appointments are difficult to come by in Crutchfield’s neck of the woods. He’s always getting calls from old friends, new friends, good friends, and relatives of friends looking to jump to the front of the scheduling line. They’ve even called his family members looking for special treatment, so he developed a straightforward system: The beggars must make an appointment for the next available slot, but if they check in every two or three days, he’ll slot them in where there is a cancellation. Most of the seekers find themselves in his office in less than three weeks.

To keep the dialogue as light as possible, he assures this group that he’d love to work all day, but he just can’t burn out his staff. He also turned over scheduling to an administrator to handle, taking himself out of the line of fire with the good cop/bad cop routine.

The great and powerful Oz

At times of great stress, the public’s perception of a doctor’s power can really come back to bite. Take the case of the neurologist who had to stand and accept condolences at his father’s funeral. “I’m sure you did everything you could, doc,” the cousins told him. “Don’t take it personally. If anyone could have saved him, it was you.” The man died of leukemia.

But this is one instance, Schorling says, where physicians have few choices other than to suck it up. “It’s hard to explain those things in a short period of time and make yourself clear without appearing defensive,” he says. Doctors who consciously try to understand their emotions of guilt and responsibility that lie at the core of these more upsetting situations usually find it easier to remain internally calm, counselors say.

Doctor, can you spare a dime?

You could make the case that folks sticking their hands out in the presence of a physician is a form of flattery. After all, it’s recognition that this profession is well compensated and represents people with well-above-average resources, Drury says.

On the other hand, don’t get Crutchfield started on how his state taxes physicians at two percent of their income to pay for its prescription assistance program. “Wouldn’t it be weird if they taxed all the attorneys to pay for a legal fund so that people could sue. That wouldn’t fly,” he says. “Or why not tax farmers two percent to buy food for people who can’t afford it.” The entire situation, in his opinion, stems from the perceived aura that physicians are rolling in dough, and therefore, an easy mark.

Patients are always asking Crutchfield if he would donate to their child’s pageant fund-raiser or to pledge so much in a marathon to raise money for their child’s band trip to Europe. If it’s a silent auction, he donates a $50 gift certificate toward the cosmetic side of his practice. He set up a foundation to handle direct cash requests, so his answer is a cheerful, “Sure. I have a charitable trust that takes applications, just like any scholarship. We review the submissions and make awards twice a year. The vast majority of people just move on. They don’t have time to file forms and wait six months. They want the money yesterday,” he says.

Since branching out to do speaking engagements, Ramirez has fielded his share of $50,000 investment requests from strangers, but he says friends who have seen him drive his Saturn about town actually call with offers to loan him money during times of national disasters. That’s because the ER doctor gives up his income to travel to the location and donate his expertise. Those excursions also give him a good reason to say no to other non-profits seeking to have a doctor on their boards.

Of course, if the cause fits your passions, doctors owe it to society to volunteer as much as the next guy, Gazelle says. But when the fit is poor or the physician suspects the group merely wants to cash in on her checking account, these polite turndowns work public relations miracles:

• “It’s a great cause but I’m stretched so thin right now, my wife says the kids don’t even know who I am. I simply can’t commit at this point.”

• “I appreciate your request, but I never answer with a yes unless I have 24 hours to think about it.”

• “I am overbooked, but perhaps I can suggest somebody.”

But no matter the words, pronounce them in kindness and you’re bound to stay on track. “There are many ways to say no nicely,” Crutchfield says. The important goal is to determine the boundaries between your personal and professional life, and then ask people to respect them. Both sides of the equation will thank you—and you’ll live happily balanced between the two. g

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Julie Sturgeon, a Greenwood, Indiana-based freelance writer, is a regular contributor to Unique Opportunities.