The one who keeps coming back

Ms. L is a 60-something year old woman who came to see me recently for follow up of diabetes, high blood pressure, and high cholesterol.  She currently takes no medications.  She has not had a baseline bone density exam or colonoscopy.  She has not had a mammogram in over 2 years.  She denies any history of diabetic retinopathy but has not seen an ophthamologist for a dilated eye exam for over a year.   She reports feeling well and has no significant medical events since her last visit.

So why is she here today?  Because I told her so.

In the past 6 months, I have seen this woman 3 times.  Every single visit thus far, I tell her that her blood sugars are high, her blood pressure is out of control, and her cholesterol could be better.  Her medication list contains five prescriptions, none of which she takes on a regular basis.   She feels fine.  She has no symptoms.  We talk about the importance of taking her medications and routine health maintenance stuff like the bone density/mammogram/colonoscopy,  and then she says to me, “Well, you can recommend as much as you want to, and you can prescribe whatever medications you want to, but I’m telling you now, I am not going to do any of it.”  I ask her to come back to see me in 2-3 months because I worry about her and a few months later, she shows up on my schedule again.

So why does she keep coming back to see me?

Fortunately this woman is very pleasant.  She always shows up on time.  She never takes up more time than her allotted appointment.  She never makes any outrageous demands for alternative health food store supplements/homeopathic remedies or narcotics.  She just doesn’t want to do the things that I recommend because she feels just fine.  From a medical-legal standpoint, I do worry that she’s going to end up with a  massive myocardial infarct or stroke because she won’t take her medications, but how much of that is my responsibility if she won’t listen to me?

I am sure every doctor has some variation of this patient.  The patient who just will not listen, but still keeps coming back for every appointment.  Obviously I am not the first physician that this patient has interacted with.  She personally has told me that she stopped going to her previous physician because they had a disagreement regarding medications.  It’s very frustrating and yet there is some tiny part of me, as a young optimistic doctor, that perhaps, just maybe, I can make a difference in this woman’s life.  Am I just fooling myself?  Is she just wasting time?  My time?  Her time?

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