I Don't Need Your Help

August 24, 2010
Jennifer Frank, MD

There are patients sometimes who try to do it themselves. They don’t want your advice on diet or exercise changes. They decline lab testing, diagnostic testing or treatment. They refuse to come in for follow up appointments. “I don’t need your help, Dr. Frank” is the message - sometimes explicitly stated.

You can imagine the scene: You are in a rush to get somewhere. You are trying to get four (or three or five or one) kids ready and into the minivan. Your kindergartner wants to tie his own shoes. “I don’t need your help Mom.”

You wait, trying to suppress your impatience. He is supposed to do this himself. You don’t have time for him to do it himself. Sometimes patience wins and you are a great mom and allow him the time to tie his own shoes. Sometimes frustration wins and you encourage him to let you do it for him because you are already late.

Similarly, there are patients sometimes who try to do it themselves. They don’t want your advice on diet or exercise changes. They decline lab testing, diagnostic testing or treatment. They refuse to come in for follow up appointments. “I don’t need your help, Dr. Frank” is the message - sometimes explicitly stated.

I wrestled with this recently after admitting one of my elderly patients to the hospital. I knew this admission was coming. He has been failing at his assisted living facility and has declined any intervention, including me making a home visit. Unfortunately, he fell and is now hospitalized. It can be so frustrating to see the end result of a refusal for help. Yet, I have an ethical and legal obligation to refrain from intervening when that is what is requested of me by a competent patient.

I don’t always handle these situations with patience. When my preschooler refuses to allow me to help her do a task only to request my help five minutes later, I remind myself that it is essential for her healthy growth and development to experiment with independence. I serve her best by giving her room to try, acknowledging that sometimes she won’t succeed on the first, second, or even fifth attempt. In moments of frustration, I have to bite my tongue to keep from scolding, “I told you to let me help you.”

With patients, who are different from my children in many notable ways, including (usually) greater degrees of maturity, autonomy, and experience, I have learned to grant freedoms, even when I don’t agree.

Sometimes, that is a two-week trial off a statin to determine if the medication is causing muscle aches. Sometimes it is accepting a refusal to help or intervene and waiting patiently for the inevitable complication to result. Sometimes it is agreeing to disagree. Rarely, it is a parting of ways as we both realize our inability to maintain a therapeutic, healing relationship.

As a mother, as a physician, as someone who tries to help, nurture, guide, and heal, some of the most painful words to hear are “I don’t need your help.”