“Patient’s will ask, ‘Do I really have to take pills? Or can I just improve my lifestyle?’”

Recently one of my patients came in after having a stroke in his eye. He asked me if he had to take the blood thinners to prevent more strokes, or if the cholesterol medicine he takes would count for this, or if he can instead simply takes care of his diet from here on out. I told him to imagine that he was in his car, and he was driving it rough. He was slamming on the brakes at 80 miles per hour. He was turning the wheel too fast, and doing a lot of rash driving. Then one day the brakes gave out. Could he say, “Well, I promise I will drive more safely and take it easy on the brakes,” and expect the breaks to be fixed? No, of course not. He would have to take it to the mechanic to either fix or replace the breaks. When you fix it, you will still want to do the right things and drive safely to make sure that the second pair doesn’t break. This scenario is the same in medicine.

I call this building the bad debt.

You keep doing all of these negative things until you have, what we call, an event. Once you have an event, it is very hard to reverse it by lifestyle changes because you had been accruing the bad debt for so long. You need something more substantial to help your body heal and prevent future events. You still want to make sure you change your lifestyle to correct the bad debt, but the medicine is helping you to reduce the event rate. Just like with your brakes, I can put my patients on as many pills as I want, but if they don’t change their habits, they may still get an event, so it is a combination of approaches that ultimately works best.

“We build our bad debt through years of poor health choices.”

You would be surprised how many patients ask these questions: “Can I refuse the medicine?” “Won’t I be okay if I just eat better?” To me, it is such a clear-cut thing; if your doctor is telling you that medicine is required, then you need to trust your doctor.

Patient’s refusal of treatment puts me, and other doctors, in a very difficult position. They come to me when they are at the beginning of heart disease and swear up and down that their natural remedies, yoga, and healthy diet are going to work magic and cure them. They refuse medicine or preventative measures that I prescribe, assuming that it is just a racket to make money. Then days, weeks or months later, I get a call in the middle of the night that they are having a heart attack. Despite their lack of cooperation and their low opinion of me, I have to leave my family and rush to the ER.

While, of course, I would never withhold life-saving help, it does bring up an interesting question: What responsibility does a patient have for their own health? By law, I am not allowed to turn away patients. Unlike other professions, which can choose their clients or refuse service, I am required to treat everyone who walks through my door even if their philosophy is different from my own. This means that the ownership of responsibility is on me despite their potential lack of compliance.

“Patient refusal costs more money than patient compliance.”

When there is such a large disconnect between patient compliance and doctor’s orders, the danger is not just for the patient’s health, but also in the ability of the doctor to provide care. When patients disregard doctors’ orders, the doctors are left with limited options. Yet, despite these limited options, the doctors are still held liable for the patients’ health outcomes.

It costs significantly more healthcare dollars when patients insist on using alternative medicine, raising the occurrence of re-admittance to the hospital and increasing the number of emergency room (ER) visits. It goes without saying that a visit to the ER costs significantly more than an annual visit and preventative medicine. The powers that be feel that we should reduce re-admittance in order to lower overall healthcare costs. In order to do this, they penalize doctors and hospitals with high re-admittance rates again putting all the ownership on the doctors whose hands may be tied.

“An educated patient is less fearful and has better health outcomes.”

As I see it, there are two solutions to this growing problem. The first is have the patients sign a waiver when they refuse care stating that they are in fact refusing care and that they are taking responsibility for their own medical needs from this point forward. This, of course, comes with its own controversy and host of problems, but it would force patients to really think about their choice and all of the potential consequences before refusing care.

The other option is to educate patients. Patients who understand the information the doctor is sharing will be less fearful and more trusting. They will be able to understand potential health outcomes of the different courses of action available to them and work with their doctors rather than against them.