One thing you learn very quickly in the clinics is that many patients willingly refuse to follow your recommended treatment. Refusing procedures, refusing medications, and taking half of the prescribed dosage are some of the issues we face on a day to day basis. For example, I recently interviewed a patient who was diagnosed with hepatitis C. Nowadays, hep C is not a death sentence and it is a relatively manageable disease. This patient refused to stop drinking alcohol regularly and refused to stop smoking. On top of this, she became cirrhotic and she was admitted to the ED because she had severe ascites (nearly 7 liters). When she came for her post-hospital follow up, we explained to her that we could help and prevent all of this if she was willing to change her lifestyle. She flatly refused, and eventually we told her to go back to the ED because her ammonia levels were frighteningly high and she was not taking the prescribed medications to deal with that.
So what do you do? The first thing I told myself is that I’m never going to get through to every patient. At the end of the day, patients have autonomy (rightly so) and they have every right to decide what happens to them (assuming they are mentally capable of making that decision). In addition, repeated office visits serve as an excellent way to bring up the issues once again. Rewording or rephrasing statements may go a long ways to ultimately changing the patient’s perspective. Patient health is an ongoing process and sometimes it takes more than one office visit to convince your patient to follow your proposed plan!