It happens to us all. I was frustrated with one of my patients about two years ago, angered because she did not want to help herself. She kept requesting help for her mental disorder, and when the help was given, she would literally run away. She would start then stop taking a medication that even she had to admit did help her. Medication was just not for her she would say to me at every visit. At first, I would strongly encourage her to take the medication. When I realized that the conversation was not going anywhere, and after several interventions from outside services did not work, I just stopped pushing it.
I stopped telling her what to do and began to guide her.
This is something we forget sometimes. Even though we truly believe in the autonomy of patients, mental disorders like severe depression sometimes do not align well with patients making their choice. I was afraid that by her having the autonomy of not taking medication, I would one day see her take her life.
Over the two-year span as my residency continued, my patient went to see other doctors in my practice. I heard from other doctors that she did not like me and wanted to switch to another provider. This disheartened me greatly because it confirmed that my aggressiveness for her to get better might have been too much. It was clear that the aggressiveness, during that time, interfered with our patient-doctor relationship. So again, I stuck with the plan. I let her take the lead in what she wanted to do for her mental health care.
Fast forward to two years later. The same patient walked in the door. We talked about how she was doing which was not very well. Then the craziest thing happened. She said “Dr. Robins, I want to be started on a medication and start therapy. Can I do that today?” My mouth dropped to the floor. The plan that I set two years ago worked. I took the approach of waiting for my patient to make the decision for herself, and it worked. At that moment, my view of medicine changed in so many ways. It reminded me of the old saying, “When the student is ready, the teacher will appear.” What a mind-blowing and career-altering experience. This is what practicing medicine means.
Individualizing care that fits our patient needs is one of the biggest lessons I have learned. As a resident who is soon to be a graduate, I am grateful for the education this patient gave me. She taught me to be patient and kind. I gave up on this patient several times. I felt like she did not hear anything I said. To my surprise, I was wrong. She heard everything! A relationship that I thought was bitter, actually is one of the most beautiful relationships I have had in medicine.
The power of the wait is real. Waiting for our patients may take a few weeks or maybe a few years. Our job as medical providers is always to be open to the possibilities. We are our patients’ guides. When they are ready, they will come to learn from you. Don’t lose hope. You may be surprised, just as I was, that your words and actions make a difference. The key is to wait to see what happens.
Amber Robins is a family medicine resident.
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