What if the patient’s choice is frustratingly ill advised?

My mother is stubborn. She occasionally approaches me for medical advice and, since I owe her more than words can adequately describe, I am happy to do what I can. Unfortunately, she is a stoic. She is also no fan of pharmaceuticals. She believes in baptism by fire, that pain purifies the soul, and what doesn’t kill you makes you stronger. So while she sometimes wants my medical advice, she rarely heeds it.

For example, my mother called to ask my advice about a “cough.” She described a productive cough with chest pain on inspiration, fever, chills, malaise, and decreased appetite that had lasted a few days. Fearing pneumonia, I told her to call her physician, and, if he could not see her that day, to go to the emergency department. She verbally agreed.

I repeatedly called and emailed to hear about the outcome, garnering no response for nearly two days. When I got her on the phone, she told me that she decided to just “ride it out” at home. Her symptoms had worsened. I immediately spun a horrifying tale about the lethality of pneumonia. I told her that the only reason that people do not die as often from pneumonia today is that we have antibiotics. If you refuse to take antibiotics, you set yourself back 100 years. I found myself screaming into the phone: “You could die!”

When she finally did go to the hospital, she had pneumonia with a loculated pleural effusion requiring thoracentesis. There was a discussion about decortication. In other words, she was very, very sick.

Let’s put aside my hurt feelings, my frustration, my fear, and my incredulousness at her response (if only it were that easy). The larger issue is that she avoids seeking treatments that have extremely high probabilities of success for illnesses that she is extremely likely to have. I now find myself melodramatizing the simplest of issues, like discussing the horrors of rheumatic fever in great detail when she may have Strep throat. Over time I think I’ve lost some credibility—crying wolf, so to speak—which doesn’t make my efforts any easier.

Is it right to discuss the worst case scenario, even if it is highly unlikely to occur, just to get my mother (or any patient) to adhere to a treatment? I could coldly recite probabilities of particular outcomes, the number needed to treat, or the percent reduction in symptoms with one management strategy over another. While that may work in some cases, how many patients do you see who make decisions based on statistics?

I think all patients should have the right to informed consent, but what if the patient’s choice is frustratingly ill-advised? I argue, in some cases, we are allowed to be a little overly dramatic. I want to be my patient’s partner in health care decisions, but I also want them to have a very clear picture of consequences of inaction. I want to provide choices, but I want to make my preference for their choice very clear. I respect a person’s right to decide their own health care, even if the patient is my mother, even if it is not the course I would choose; but I reserve the right to champion the option that I think is clearly best.

Michael Todd Sapko is a medical writer and consultant. He writes for Healthline.com.

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