There’s a patient I don’t like very much. I’ll call her Mrs. X.

Mrs. X has definite medical problems, though she doesn’t seem to think so. Her lipids and blood pressure really are much higher than they should be. She could stand to lose a couple of pounds, and she really should be more active. She does not concur.

Every time she makes an appointment, she calls and changes it three, four, five times. After all that, she often doesn’t show up.

The first time I saw her, I identified several health issues. I told her that her blood pressure was too high, as was her cholesterol.

Her response: “I disagree.”

Say what?

“I don’t really think I have much of a problem. I’ll see if I can do something about the way I eat, but I’m not really worried.”

That made one of us. The BP was 190/114, with fasting triglycerides over 700. Her liver function tests were also abnormal (no surprise with TGs that high), so I asked her to get an ultrasound of her liver.

“I don’t think that’s necessary.”

OK then.

She agreed to begin a medication, for which I asked her to return in three months for a blood test. She took the prescription, and vanished for a year and a half. After a while, I got a notice from the pharmacy that she was requesting a refill. I refused, telling them to ask her to call for an appointment. Six months later, she did. Then she re-scheduled it three times, no-showed once, called again, and finally came in … late.

Without exaggeration, I can say this patient has repeated this cycle at least three times since I’ve known her.

Make no mistake: I have plenty of patients who are reluctant to take my advice about their health. I’m not even quite sure what it is about this person that rubs me the wrong way.

Why does she expect me to continue calling in prescriptions without seeing her to monitor them? It’s as if she doesn’t seem to feel that the rules for everyone else (coming to appointments on time, for example) should apply to her.

As I say, I don’t quite understand why this particular patient has this effect on me. Suffice it to say that I cringe a little whenever I see her name on the schedule. Then I reassure myself that she probably won’t show up, and two out of three times I’m right. But when she does, I know it’s going to be a frustrating encounter.

Is there anything I can do? Firing her is an option, though a bit of an over-reaction as I don’t really have grounds for something that extreme. Stop prescribing without visits? I have, though I fear for her health.

I guess I’ll just keep on muddling through.

Lucy Hornstein is a family physician who blogs at Musings of a Dinosaur, and is the author of Declarations of a Dinosaur: 10 Laws I’ve Learned as a Family Doctor.

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