Treatment Refusal

July 30, 2008

While riding the jeep to school, I overheard this conversation.
“You’re now a diabetic?” a woman said to a man, who was obviously her friend. She wore what seemed to be a uniform of some generic office. He, on the other hand, was wearing home clothing.
“That’s what the doctor said,” the man said.
“You should go natural,” the woman said. “Don’t drink. Don’t eat too much. Go natural. Exercise.”
“No,” he said in obvious denial of his condition, “I feel fine.”
“Your condition might worsen,” she said. “You’ll end up injecting yourself with expensive medicine everyday.”
“I don’t care what the doctor says,” he said. “As long as I feel fine, I’ll do the same things I do normally.”
Now I must admit that I have a strange sense of humor. I don’t know how other medical students would react to this situation, but I just smiled. Call it weird, but I can’t help but imagine what this man in the future might look like. He’ll be weak, thin, and wasted. He’ll also be mouthing his regret over not changing his ways. Yet by that time, there would no longer be any major benefit from his reformation. He’d either end up dead or be sick for a long time.
To anyone think that I have a sadistic streak, “stop it”. I was just amused by the man’s stubbornness. It would allow him to enjoy a happy lifetime, but it would be a shorter lifetime. Also, I greatly respect autonomy. As long as an adult individual has sufficient mental capacity, he has the right to undergo or refuse treatment. The smile was also brought about by a small streak of what my future would bring. I’d be handling stubborn patients like him, who wouldn’t follow my instructions. Call it grim humor, because that’s what it is.
My smile was noticed by the woman. I believe she also noted my distinct* white uniform and the giant Pediatrics book I was holding because she turned the man’s attention to me.
“Am I speaking right?” she asked, and then turned to the man. “He’s a medical student, a future doctor.”
Trying to hide the grimace building up from her last statement, I nodded and smiled at them. No matter what I’d say, the man would still stick to his ways. If he didn’t believe what his doctor told him, he wouldn’t believe what a “future doctor”** would tell him. I left them shortly afterward.
I just knew the woman would still be trying to convince the man. The man, however, would not follow her. I consoled myself that the decision was his to make. Then I had an insight:
Doctors, ultimately, have a vital goal in order to fulfill their calling. They may know how to diagnose, cure, or manage a disease or condition. Yet their vital goal is to first convince their patients to agree to get well.

*Our uniforms are different from the Nursing students’ uniforms.
** Somehow, this just makes me cringe. There’s still about 5 years to go before I can claim the coveted MD degree.



  1. Great vignette, and interesting insight. Your piece makes me wonder, though, if the special skills (and limited time) of doctors might not be better used to help those who explicitly want to get well, rather than those who still need convincing.

    Your job as a healer will be hard enough, once you start in a few years. You shouldn’t have to take on the job of cheerleader as well.

    Hope you keep writing more about your journey towards your medical degree, and beyond. Good luck.

    • Thanx, molavem. Your insight is also mighty interesting.
      Come to think of it. In a pragmatic sense, only those who are willing to benefit from being cured should be cured.
      On the other hand, what if the patient is a loved one? What if that patient is in denial and refuses to be treated? Should that patient be denied healing?
      Yet ultimately, all patients are loved ones of other people. Should doctors be concerned only of the well being of the sick? What about those who will be affected if the sick one should die?
      Not that I would sign up as a cheerleader to perk people to get well. I don’t think I’m cut out for that line of work. I also don’t think it is ethical to force people to do things they do not like. Patients do have the freedom of choice. It is ultimately up to them if they want to get cured or not.
      So I guess there should be a limit to how much a physician should encourage patients. It may vary in a case to case basis. I just can’t say right now how much it should be. I still need clinical experience for that.

      PS I just thought about these things just now. Thanx for the push. =)
      Hmmm. I guess I now have some picture of what holistic medicine is about.

  2. It was a pleasure to “push.” =) I appreciate how you use blogging as a platform to explore this issue, which really is relevant not only to doctors-to-be, but to the public in general. We need more people to ask questions like you do.

    Please drop by our own blog http://www.rxpinoy.net if you have a little time. It’s still very young, but we’re hoping to encourage more dialogue like this as we move forward. Cheers, and Happy Holidays!

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