This is an open letter to all physicians who feel the need to drop patients for non-compliance — refusing tests, procedures, or otherwise ignoring medical advice. Feel free to reprint or post anywhere, just give credit to the source. 🙂
An Open Letter to Physicians Who Drop Patients for Non-Compliance
It has come to my attention over the last several months that some of you are choosing to drop your patients for non-compliance. This may be because they choose to use a doula in birth; or because they are refusing a routine IV or vitamin K shot; it may be because they won’t vaccinate; or possibly because they won’t allow a certain test or take a certain medication.
Although you have gone to medical school, and have specialized knowledge; and this is America where you can privately choose to practice however you want (refusing service to anyone for any reason), I think this is a pretty terrible way to practice medicine.
A doctor-patient relationship should be a partnership. Your patient has hired you as a service provider, because you do have specialized training and experience. Your patient should then feel comfortable with you and be honest with you regarding his or her lifestyle and choices, so that you can make recommendations and best treat the individual patient based on his or her individual circumstances. In this type of situation, you are a wealth of knowledge and an amazing resource. Patients truly appreciate doctors like this more than you may ever know.
But what happens when a doctor is rigid about procedures and policies is that patients are turned off. That is arrogant. You might as well say, “I went to medical school and you did not, therefore I know all the answers and you know nothing. When you come into my office, you will follow my advice or else. I have all the answers and your individual preferences and choices mean nothing to me. You are a patient who should absorb all my knowledge and wisdom and be grateful for it, do not dare to question me.”
I have even heard some doctors actually say parts of this to their patients.
This attitude destroys all trust. It makes it likely that patients will lie to you, or simply stop seeing you. Those who don’t have other options may simply stop seeking medical care. This can lead to a situation where, if they ever got sick, they would have no one who was familiar with their medical history to turn to. Even if they could still seek care from you (assuming they’d even want to), they would not have been honest with you because of your careless disdain for their choices, and you could easily miss something critical because of an incomplete medical history.
Does that fulfill your Hippocratic oath?
(And let’s not forget, though I think all doctors have, that the second part of the Hippocratic oath is “Let food be your medicine, and medicine be your food.” Does that sound familiar? Obviously not, given the way the vast majority of doctors practice now!)
It’s also unfortunate that most doctors are most likely to drop patients who seek non-mainstream care, or live by non-mainstream ideals. They’re too cautious of upsetting the doctor-patient relationship to tell most patients that they need to lose some weight (no matter how true that may be), but they’re not afraid to callously ridicule and attack parents who choose not to vaccinate. Doctors are careful to respect a patient’s right to drink, but they can’t stand it if their patients refuse to take a particular drug! Some doctors will roll their eyes and walk out of the room. Others will berate the patients. Still others simply say, “Leave and do not come back.”
What happens if your patient is in immediate need of medical care? For example, a chronic condition (that, perhaps, the patient would like to try to manage without drugs) or about to deliver a baby? You may have left your patient with no medical care. Whose fault will it be if something goes wrong for that patient? You will not take the blame, though, because you will say “If s/he had only listened to me….”
I have news for you: you’re human. You are not God. You are not magical. You have specialized knowledge in a particular field. People seek you out for help because of it. But you do not have all the answers. You have your natural biases and preferences, like all of us. There may be things that you don’t know. There may be another way. Think of yourself as a service provider, one who does the absolute best to help patients while respecting them as human beings who can also make decisions and do research for themselves. Your patients are not idiots. They are capable of reading medical journals too (and some do!). They should be able to bring you this information and ask you honestly what you think of it, and if it could help them — and get a straight answer from you, even if that answer is, “I don’t know, I haven’t come across that research before.” Admitting your limitations goes a long way.
Doctors: please change your policies. If you absolutely must drop patients for non-compliance because you cannot handle being questioned (ahem), you should tell your patients this at their initial appointment and write it down clearly in your office policies. Something like, “If you do not follow recommended procedures or advice, you will be removed from the practice.” Make sure your patients know the first time they see you. Hopefully they will be smart enough to walk out of your office immediately without looking back. You owe it to all your patients to make your policies clear so that they can fire you first if they don’t want to deal with it (and they shouldn’t have to!).
Also — please don’t make your patients sign an insulting “non compliance” letter as an alternative. There are letters out there that are just fine, but many are terrible. Most letters basically imply that the patients are idiots and are putting their lives (or their children’s lives) in jeopardy. These letters seek to make it look like the only answer is the doctor’s answer. These are typically used when parents choose not to vaccinate, and say things like, “I understand there are risks to choosing not to vaccinate, vaccines are very safe, and by refusing them, my child may die.” These letters can and have been used against parents when Child Protective Services got involved. Parents — do not sign this!! If you need to use a letter like this, doctors, you can make it say this: “I recognize that there are risks to refusing this procedure, but also risks in having this procedure, and at this time I decline.” That’s fine.
Thanks for reading this, doctors and patients alike. Here’s to hoping that in the future, we can get back to the trusting, mutual, honest doctor-patient relationship that used to exist, and in some cases still does. We need more doctors like this. If you are one, congratulations and thank you so much. If you are not…pay attention. Eventually you will lose all your business, as you should. Wise up now and start treating your patients like rational human beings, and you’ll see your entire practice change for the better.
What do you think about doctors who drop patients for non-compliance?
Confused about vaccines?
Get our FREE no-nonsense vaccine guide. Answer your questions with rational, fact-based information instead of fear.