Search tips
Search criteria 


Logo of bmjThis ArticleThe BMJ
BMJ. 2007 August 25; 335(7616): 398.
PMCID: PMC1952495

Can you say “no”?

Heyam Awad, consultant, Tameside NHS Trust, Manchester

The distance between yes and no is the same as that between slavery and freedom. I left a third world country to come to the UK thinking that I had jumped over the barrier between yes and no, leaving slavery behind.

Early in my career as a trainee in histopathology, I was reporting a case of a basal cell carcinoma with my consultant. His instructions were to report the case according to the standards of the minimum dataset of the Royal College of Pathologists. This includes mentioning whether there is perineural invasion and lymphovascular invasion. I am not convinced that this is needed in all cases. Perineural invasion is rare and seen usually with only one type of basal cell carcinoma. The lymphovascular invasion is even rarer, if it occurs at all.

I mentioned this to my consultant, who said I was correct but that, as long as these criteria were on the dataset, we had to fulfil them.

“Why?” I protested.

“Because this is what the college wants us to do.”

“What if we do not see a point of this?”

“I do agree with you, Heyam, but we still cannot say ‘no.'”

What a surprise. Wherever I go, wherever I live, “no” is still a difficult word to say.

Articles from The BMJ are provided here courtesy of BMJ Publishing Group