Letter to the Editor

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.