"Sometimes, the Hardest Part of Medicine Is the Patient."

 "Sometimes, the Hardest Part of Medicine Is the Patient."

by:

Virgilio F. De leon Jr. MD

I have been involved in the medical and paramedical fields for more than two decades—as a first aider, lecturer, and doctor.

Throughout my career, I have encountered countless patients, each with different personalities, beliefs, and attitudes toward their health. Some are easy to convince when it comes to taking care of themselves. Others require more explanation. And then there are those who resist medical advice, either directly or indirectly.

When I was starting out, these patients frustrated me. In my mind, who would willingly argue against something that could protect their health or even save their life?

Over the years, however, I have come to recognize three particularly difficult types of patients.

1. The Intellectual

Some people rationalize everything you tell them. They analyze, debate, and sometimes use their own reasoning to dismiss sound medical advice.

I once had a patient who proudly told me that he no longer monitored his blood pressure because he did not experience any symptoms whenever his blood pressure increased.

Knowing that both of his parents had a history of heart disease—and that one of them had died of cardiac arrest—I was concerned. So I asked him:

“How would you know your blood pressure pattern if you do not check it regularly?”

Some people become so accustomed to having high blood pressure that they no longer experience noticeable symptoms. But the absence of symptoms does not mean the condition is harmless. Their bodies—and particularly their hearts, brains, and kidneys—may still be sustaining damage.

His response was essentially that he was still alive, so there could not be much of a problem.

I wanted to argue further, but even a doctor’s patience has its limits.

2. The Spiritual

A relative of mine once stopped taking his medications because he believed that God would take care of him and heal him.

I grew up in the Church. I believe in the power of prayer, and I believe that healing can come through faith and blessings.

However, as a doctor, I cannot condone the decision to stop essential medications simply because of one’s religious beliefs. I have argued that medicines can also be blessings from God. The doctors who prescribe them, the researchers who develop them, and the people who care for us can all be instruments of that same grace.

Unfortunately, my relative eventually died after suffering a second stroke.

Was the outcome inevitable? I honestly cannot say. But I cannot help wondering whether stopping his medications contributed to what happened.

I hope he is at peace.

3. The Superstitious

We once had a helper who complained of a persistent cough. She had asthma, and despite the explanations, treatment, and medications we prescribed and paid for, she was not improving.

Eventually, we discovered that she had not been taking her medications. She was not using her nebulizer, either.

Instead, she insisted that the cause of her persistent cough was an elemental living in our laundry area.

According to her, this elemental was causing her harm, and no medicine I prescribed could possibly make her better.

Now, I do believe in elementals and in other things that go bump in the night. I have seen unusual things since I was a child. But because of that, I was also fairly certain that there was no such presence in our laundry area.

I have been to hospitals, graveyards, and deserted places where such things are said to abound. Our laundry area—and the surroundings of our home—were not among them.

I hope she eventually found an answer through the local healer in her province. Unfortunately, I had no answer for her here.

Over time, I have come to realize that people carry deeply rooted beliefs about their health. Some rely too heavily on their own reasoning. Others place all their trust in faith. Some turn to superstition when medicine fails to produce the results they expect.

As a doctor, it is not always my job to change their minds. My responsibility is to explain their condition, present the available options, and help them understand the possible consequences of their decisions.

In the end, they still have the right to choose.

And sometimes, that is the hardest part of medicine.

You can prescribe treatment. You can explain the risks. You can offer guidance.

But you cannot always convince someone to accept the help that might save them.