“You doctors just want to give me poison and I am not going to take it!” I have been accused of many things in my 20 years of practice but intentional poisoning was something new and the patient's words surprisingly harsh. He was angry from the moment I walked into the room. He was first offended when I questioned his reasons for not taking the medications his cardiologist had prescribed. He had experienced some slight swelling of his legs, decided that this side effect was too severe and made the decision on his own that the medication was unsafe. He was convinced that the doctor had put his health in danger and that I wanted to do the same.
When I explained that this was a relatively common side effect with this medication he became angry. “Why would you prescribe a medication when you know there are side effects?” He was nearly shouting and his faith was contorted in anger. He was MAD!
“Because it is an effective drug and the side effects only happen ten percent of the time!” Was my reply.
He would have none of it. It was his opinion that no doctor should ever prescribe any medication if there were any side effects. I tried to explain to him the nature of side effects and how they were outweighed by the benefits of treatment. I spent the next 20 minutes trying to explain to him the nature of heart failure and why medicines were crucial for his health. I explained how the medications worked and why the side effects were reversible or manageable. He argued with me every assertion I made. He told me that doctors were dishonest people who cared more about money than they did people, unscrupulous individuals who would just as soon poison someone as treat them.
I finally gave up. As calmly as I could I told him that if he was going to refuse care for his heart failure that I would not be his doctor. If he didn't trust me it would be impossible for our relationship to continue. I explained that my preference would be for him to remain a patient and be healthy but that remaining a patient and being healthy would mean following my instructions. He continued to argue with me so I opened the exam room door and gestured for him to leave. “You will need to find another doctor,” I told him, and sent him on his way.
After he left I composed a letter summing up what had happened (detailed documentation is required when a patient is dismissed) and put it in the mail. I reviewed our conversation and concluded by saying,
“You made it clear that you do not trust doctors, myself included. The physician/patient relationship has trust as its foundation. Your good health and medical treatment is dependent on you following expert medical advice. Our lengthy conversation today proved to me that you are unwilling to do this.
If you wish to remain a patient in my practice, you will need to accept and follow my recommendations, and schedule appropriate follow up visits. If you are willing to follow my recommendations and respect my judgment and opinions, please schedule a visit to move forward with your care.
If you plan on continuing to argue with my recommendations and refuse to comply with treatment plans, I must insist that you seek care elsewhere.”
I had my staff send the letter via certified mail, convinced that I would never see him again. Which is why I was so taken aback when I saw his name on the schedule 5 weeks later. I entered the room cautiously, prepared for another conflict.
It never came. He was incredibly apologetic from the outset. I asked him what changed his mind. He told me it was the letter! He realized that I was serious about his health and decided right then that he didn’t want to see anyone else.
His dramatic change of heart was something else I had not seen in 20 years of practice. I was truly impressed with his humility and told him so. We agreed on a new medication plan for his heart and blood pressure and arranged a follow up visit. It was a very pleasant encounter.
It was also educational. He taught me that people can change, even those who seem intractable and unreasonable. He reminded me of the power of forgiveness and the beauty of a fresh start. I am actually looking forward to our next visit.
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