Letter to the Editor
A reader responds on dismissing nonadherent patients
The article “Look for reasons if patients refuse advice” in the February 2014 ACP Internist raised many interesting points, but I strongly disagree with one of them, that it is unacceptable to dismiss a patient who won’t comply.
I’ve always believed that patients should have the right to make medical decisions about their own lives. But 2 major concerns have combined to change my opinion about remaining the doctor for patients who refuse to follow my advice.
First, there is the legal aspect. In our paternalistic legal system, the doctor is at least partly responsible for bad outcomes of patients’ noncompliance. Please note the “Additional reading” section of the article, which referred to an article titled “Documenting noncompliance won’t protect you anymore.”
The second aspect is more important from a patient-centered point of view. What if, despite the doctor’s best efforts, there’s a flaw in that doctor’s communication skills? Or what if there’s some sort of interpersonal mismatch between that particular doctor and that particular patient? Isn’t it possible that the patient who doesn’t follow doctor #1’s advice might connect with doctor #2, and then comply? Isn’t it plausible that if doctor #1 doesn’t dismiss the noncompliant patient, the patient will be harmed?
Daniel A. Reinharth, MD, FACP
East Meadow, N.Y.
Internist Archives Quick Links
What will you learn from your Annals Virtual Patient?
Annals Virtual Patients is a unique patient care simulator that mirrors real patient care decisions and consequences. CME Credit and MOC Points are available. Start off with a FREE sample case. Start your journey now.
Internal Medicine Meeting 2015 Live Simulcast!
Unable to attend the meeting this year? On Saturday, May 2, seven sessions will be streamed live from the meeting. Register for the simulcast and earn CME credit after watching each session. Watch it live or download for later viewing.