How often are you faced with a situation in which a patient has been diagnosed with condition X and needs treatment Y? How often has your patient refused the best treatment?
I was faced with a similar situation just this week and I tried my best to understand the thinking behind refusing treatment/advice for a newly diagnosed problem.
Maybe our patients are denying the new finding. Could it be that they are refusing to accept the new finding? Whatever their reason for refusal, or reluctance to accept the proper advice, we must do our best to try to understand or possibly educate our patients as to why our advice is best for them.
In situations where my patient might refuse to accept my advice, I will recommend that they see one of my colleagues for a second opinion consultation. Frequently, a recommendation for a second opinion will result in the patient agreeing to the treatment plan I have advised for them. For patients that are reluctant to follow through with the second opinion consult, I will ask them to sign a form indicating that they are refusing to accept a treatment or recommendation that is considered to be the national standard of care.
Putting the legal risks aside, you can avoid those potential problems with proper documentation. However, I was faced with one situation just earlier today in which one of my patients presented to the office with increased swelling in his left lower extremity accompanied by pain and redness of the thigh. A quick trip down to the radiology department demonstrated the patient had an acute DVT. When he came back to the office to discuss the result, he was reluctant to accept my recommendation for hospitalization and initiation of anticoagulation. After a lengthy conversation and repeated attempts to urge him to take my advice, he finally consented and was admitted to the hospital.
Another patient presented to the office with bright red bleeding per rectum for several weeks. He had this complaint once before and had refused my recommendation for colonoscopy. At the time he was in his mid 30s and passed off the symptom as likely due to hemorrhoids. I explained to him that he should not assume and should have the test anyway. He refused. He came back to the office just earlier this month and now in his early 40s is scheduled for a colonoscopy next week.
In my experience, most patients will generally tell me that they will do whatever I advise them to do. Fortunately, this is true for greater than 95 percent of my patients. However, the remaining minority of patients such as the ones listed above can lead to frustration on the physician's part and can cause decreased job satisfaction.
For those patients that are reluctant to accept advice, I will simply tell them this: "...If you were my (insert closest age of family member or friend here), this is exactly the same advice that I would hope their physician would give to them." This is my last ditch effort to persuade my patients to take their condition more seriously and fortunately a large percentage of the 5 percent begrudgingly accept my recommendation and are very well satisfied in the long run.
I find that my patients truly feel as if I am genuinely interested in their well being and most of them tell me so. If you treat each patient as a spouse, parent, sibling, child, etc., and you do exactly what you would want to be done for your relative/friend in a similar situation, you can rest assured that your patient is being treated properly.