American College of Physicians: Internal Medicine — Doctors for Adults ®


Letter to the Editor

From the May ACP Internist, copyright © 2014 by the American College of Physicians

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.


This is a printer-friendly version of this page

Print this page  |  Close the preview




Internist Archives Quick Links

Prescribe Opioids Safely

Prescribe Opioids Safely

Access this FREE online educational program to help you safely prescribe opioids and manage patients with chronic pain. Online CME is available. Find out more.

Inspire the Next Generation of Medicine

Inspire the Next Generation of Medicine

Contribute to the ACP Education Fund and support our profession and the young minds starting their careers.

Share your love of medicine by making a charitable donation today! All donations are tax-deductible.