Philip Welsby explores the difficulties that can be faced in answering ‘yes’ or ‘no’ questions in general practice…

To my annoyance a politician was being interviewed on television. That in itself is perhaps annoying enough, but he would not answer a simple question with a simple answer. He kept on talking and had to be interrupted several times by the interviewer in a failed attempt to get a simple reply. Something along the line (I make this example up) “What is 2 +2?” and the answer “Well that’s easy to answer. The government solved the 1 +1 problems and now we have to roll out a world beating system that will include division and multiplication that will not subtract from our achievements in the past and in the future. But our focus is on the present, and we will be led by the science and practicalities of the situations as they arise at the time. And, by the way…” and so on and on…

This reminded me of one instance when I had to be less than forthcoming when asked Yes or No questions.

Many years ago when I was a locum General Practitioner I was halfway through a peaceful afternoon surgery when a pair of sweaty breathless males presented themselves in advance of the patient next on my list. The receptionist felt they had to be seen immediately and she, correctly, could not give the information they requested. They claimed to be detectives hot in pursuit of a criminal and they wanted to know whether I had seen him earlier that afternoon. I checked their identification and was then faced with an acute confidentiality problem as I had seen the patient who seemed a decent sort of chap. I obviously could not lie and say I had not seen him. Equally if I said I had to consult my Medical Defence Union then this would be tantamount to revealing that I had seen that patient. I was just about to say “I could not possibly tell you” when I thought on (that tells you the Practice was up North) and asked why they needed to apprehend this chap. My judgement that he was a decent sort of chap was rapidly reversed and there were several very good reasons why he should be removed from society without delay. So what did I do?

What would you have done?  I told them “I could not possibly tell you” whilst looking at the bundle of paper files (electricity for electronic records had not then been supplied up North, I jest) stacked up under a “Patients Seen” label.  They made a totally unjustified interpretation and departed without the need for a prescription or description issuing thanks as they sped away.

Sometimes “Yes” can be used as an acknowledgement that you were listening rather than agreeing. Occasionally intravenous drug abusers would make outrageous provocative opinions of one of my colleagues “Dr X is a fool” expecting me to react aggressively. The best response was an offhand “Yes, and he is a better doctor than I and the treatment he gave was first rate.” Note The “Yes, and..” that is less confrontational than ”Yes, but…” Humility often defuses confrontation.  On the other hand, sometimes a reply “Yes” seems to be disregarded by a questioner who immediately follows up with “Yes but…” To avoid this if you want to be unequivocal say “Absolutely!” (with stress on the exclamation mark), rather than a mere “Yes.”

Finally, a lecturer made the point that two negative “No’s” make a positive but two positives never make a negative. From the back row there was a stage whisper: “Yeah, Yeah.”