Difficult Patients: Should You Give Up on Them?

How long should you beat your head against a wall before finally realizing you aren’t accomplishing anything?

I’m talking about dealing with difficult patients who insist on continuing their self-destructive behavior, or who don’t follow recommendations, or who continue to resist change—essentially, they just don’t listen to a thing you say?

In the lingo of the health profession, I’m talking about “the non-compliant.”

A person in my family is gravely ill and has health problems that are solely due to really bad lifestyle choices. He’s the poster child for how not to live your life. He ate poorly, smoked and rarely exercised. I can still see the mayo he piled high on the baloney sandwiches, the two hot dogs he made a habit of eating every day, and the thousands of dollars he spent on cigarettes.

Now this person is debilitated and in pain, and the best we can hope for him is a quick death. My family members are doing everything they can to make the time until that happens as comfortable and as safe as possible, but it isn’t easy; he is still resisting. I guess it’s time to accept that this is the way it’s going to be until the end.

You know patients like this. They suck up a lot of time, energy and monetary resources, and cause those who have to watch their deterioration a lot of heartache. Their behavior raises a lot of issues – medical, ethical and moral.

How responsive and responsible should family and friends be when these patients are unresponsive and irresponsible?

Should these difficult people be required to carry more of the burden or cost of care by paying higher insurance premiums? (Some already do; for instance, state employees in Alabama must pay $25 a month, versus nothing, for health care insurance if they smoke or are overweight.)

Are members of the medical profession bound to keep plugging away, hoping difficult patients will change, or do we give up at some point? How far does our professional obligation go?

Tell us what you think.