You cannot treat a patient against his will

Year: 2002

Setting: Gleneagles Hospital, Singapore
Position: Private general practitioner

I am the first and only non-Anglo-Saxon, foreign, private general practitioner in the city-state and the physician of reference for 14 embassies, consulates and a high commission from Europe, Asia, South America and Africa. One afternoon, a nurse comes into my consulting room saying that an ambassador from a European country has had an accident and that he insists on being seen immediately.

I greet him and learn that he has slipped on a wet marble floor and badly twisted his right ankle. I get an X-ray to make sure there is no fracture. Then, because of the severity of the sprain and the intensity of the pain, I recommend a walking cast. He retorts that he will make an appointment with an orthopedic surgeon for this procedure, against my advice. I tried to argue that the longer he waits for the cast to be placed, the longer the recovery time will be, but the patient insists on his own course of action. We bid each other farewell by sharing the latest ex-pat joke. I do not see him in the subsequent weeks and assume, by default, that all is well.

However, about two months later I am attending a function with representatives from the diplomatic corps and I spot him in the crowd, hobbling about with a cane. As I approach, his group, his wife comes to me and makes the following request: “Please don’t be too hard on him. He did not follow your recommendations because he does not want to be seen in a cast.” I have witnessed this kind of behavior before. Some people, when they have reached a prominent social status, refuse to adopt behaviors they think will damage their image. I cannot help but think that, had he allowed me to put his ankle in a cast, he would be happily walking by now, even running if he wanted to. I call the waiter for a cocktail and forget about it by mingling with the crowd.

Lesson for the doctor: You cannot treat a patient against his/her will.

Yann Meunier is the health promotion manager for the Stanford Prevention Research Center who blogs at Scope at the Stanford University School of Medicine.

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