Coping with oppositional patients

Last week, I saw a patient who wanted to discuss her dysmenorrhea. Her periods had been growing increasingly painful, and she wanted to know what I could do to make her feel better. But as I described each potential treatment, she came up with a reason she could not or would not try it.

“So basically there is nothing you can do to help me,” the patient said, after I had exhausted every treatment possibility, including alternative options, such as homeopathy and acupuncture. 

I'm sure that this patient left the office with frustration equal to mine, but it made me wonder what exactly she was looking for or if I missed part of the picture. Was the patient seeking narcotics? Or was there something that she wasn't telling me?

Like many health care professionals, I am a fixer. It's hard for me not to get exasperated when I have trouble helping someone, and worrying about patients often keeps me up at night. When someone comes to me with a problem, I want to do everything in my power to find a solution. 

It's not uncommon for me to spend hours helping patients find specialists that will take their insurance or a pharmacy that carries a particular medication. I will research alternative therapies when a traditional treatment does not seem to be working. But I do need some help from the patient. 

If a treatment plan is to be successful, we need patients who are interested in playing an active role in their health care. That means creating collaborative relationships with patients who are willing to be a part of the team. 

I understand that my advice may not always be something patients wants to hear. Sometimes they disagree with my opinion that their weight gain is due to a poor diet and lack of exercise, for example, and insist that their hormones are to blame.

Despite these disagreements, most health-care providers are willing to go out of their way to create a treatment plan that works. But patients must be willing to meet us halfway.