Patients aren’t perfect and neither am I

I get it. I really do. If a patient won’t trust you on the most fundamental of medical facts, how can you be an effective doctor to them? An article circulating on social media argues this effectively–to a point.

If I were a pediatrician, I would be wary of allowing unvaccinated patients into my office. They may bring diseases into my office and infect kids who can’t get vaccinated for medical reasons. They may be more likely to catch diseases in my office. But that’s not what was argued. The argument was one of trust. How can I care for someone who doesn’t believe the most important things I tell them?

My answer to this “grow the fuck up.” People are imperfect and irrational. That’s how we’re built. The patient who believes they can can cure diabetes with cinnamon rolls may also take your advice to go on a statin for heart attack prevention. They may agree to medicine for blood pressure even though you think exercise and diet changes would be better.

Caring for other people is not about fulfilling your own needs but those of your patients and of public health. I do everything I can to persuade patients to take my advice, including getting recommended vaccines. I am blunt about the consequences of their decisions. But after that it’s up to them. Paternalism is a useful tool, but a useless rule. A good doctor must collaborate with patients and should only give up on their care if there is a real breakdown in the relationship.

If you choose only to treat rational people, your waiting room is going to be pretty quiet.

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3 Comments

  1. I wish there was an applause button. Brilliant post, doctor.

  2. Vicki

     /  February 4, 2014

    i think the argument for not taking unvaccinated patients is that they may infect other people in the waiting room–so it might be valid about the MMR or pertussis, but isn’t a reason to turn away patients who don’t want to be vaccinated against hepatitis.

    on other things, well, my willingness or otherwise to eat a healthier diet or get enough exercise isn’t going to affect a stranger in the waiting room; neither does his smoking affect me, if he doesn’t do it in or right outside the doctor’s office.

  3. “grow the fuck up.” Rule #5 is about challenging oneself to improve.

    Microphallerati is my new favorite word, btw. I plan to steal it and bastardize it to “microphallati.” I can think of about a million ways to use this. I might even have to start writing again….

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