How Involved Do You Get When a Patient Refuses Treatment?
How Involved Do You Get When a Patient Refuses Treatment?
The Scenario: One of your patients refuses the medication/treatment you know will best help him. How hard do you push the patient to accept your recommended course of action, and when do you let it go?
The Dilemma: There’s no clear cut answer in this type of situation. Do you involve family members who may help change the patient’s mind? Do you ask other physicians/staff members to talk with the patient? Do you respect the patient’s decision and leave it at that? Does it depend on the scope of the healthcare problem and the implications not accepting treatment will have on the patient?
What Would You Do: When faced with situations like this one, what strategies would you employ to achieve compliance? In the comments section below, share what you would do and why. Your response might help another physician deal with this issue.
I would try to step back and ask the patient for the concerns they felt over the matter, first. Then, I would address the concerns and try to breakdown the diagnoses for them and present the reasons the treatment is needed or crucial. If they then are totally informed and still choose not to get the treatment, and they are psychologically sound, then you must accept the decision. Have them sign what ever forms needed for release of medical liability.
In our field, in addition to being "totally informed", many patients must also deal with the stigma that goes with being labelled a " psychiatric patient", even among the medical community. Patients sometimes present for treatment inspite of, not because of their loved ones. It is therefore important to consider this when a patient refuses treatmnt especially, medcations. In many cases patients would still come for follow up time after time ,despite not taking the prescribed treatmnt ( and pay their copayment!). My experience in the many years of practice has taught me that the ongoing intereaction helps gain insight and breaks down the effect of this stigma. Eventually many patients agree. After all we all go for medical help because we are in some distress. There are complex reasons why one would "refuse treatment". Similarly, on inpatient settings a patient exercising their legal right to sign out against medical advice should not be allowed to leave without efforts at adressing their reasons.
There were instances on medical consultaions when such a patient turned out to have had delirium and taken these decisons in the non lucid state, which manifested as a "difficult patient"
I am a psychiatrist. In a field that is still fighting the culture of stigma, it is not unusual to encounter such refusal or rather reluctance to take a recommended medication. There is also a lot of information and misinformation out there on the web , enough to scare anyone.
My philosophy is that most people come to see a doctor because they need help. The fear is how to assess the competent doctor. Afterall there are media programs that depict doctors as being bribed by drug companies with lunches, pens ! it is therefore important to view a refusal of a recommended treatmnent as an opportunity to eplore the patients concerns, no matter how outlandish it sounds and educate the patient- not just in our medical jargon but in layman terms. We should not view it as an issue of a" difficult patient" but a patient trying to advocate for themselves. it has worked for me. Even those who initially refuse, i explain the likely result of untreated ilness on their quality of life , suggest they get a second opinion if they prefer( without sounding peronally hurt) In 20 + years of practoice, I have seen enough patients change their minds or come back to thank me even years later- thanks for helping them understand their illness - the first step to becoming a partner in ones treatment. Yes it can take more time than usal for some people but contributing to the quality of those patient's lives is worth it