“Doctor, it’s not my portion. I don’t have hypertension,” she said confidently, shifting her wrapper and returning my gaze like I had just accused her of something terrible.
The blood pressure monitor read 170/120 mmHg. I had just measured it myself twice, yet here I was, facing a patient who flat-out refused to believe her numbers.
She was a middle-aged woman who came in complaining of a headache and body weakness. She looked stable, and I initially thought it would be a routine visit. But the moment I mentioned her blood pressure and the need for further evaluation, everything changed.
“Hypertension? No, no. God forbid. I will never have high BP,” she insisted, shaking her head.
I tried to remain calm and explain what high blood pressure meant, how most people don’t feel symptoms until it’s too late, and how early treatment could protect her heart, kidneys, and brain. But my words didn’t seem to land. Instead, she quoted a neighbor who “rejected” the diagnosis and was fine without medication. She was polite but firm. I could tell she had already made up her mind.
I felt dejected, confused, and sad. But this wasn’t new. I had seen many patients like her; people who associated a diagnosis with defeat or spiritual weakness. In some communities, acknowledging a chronic illness like hypertension is equivalent to inviting doom. Denial becomes a kind of shield, a way to avoid fear, stigma, or perceived spiritual attack. But for us clinicians, it’s a dangerous barrier to care.
I remember a young man who also dismissed his high readings because “hypertension is for old people.” He showed up three months later with a stroke. Others came in with heart failure, kidney damage, or sudden collapses — all from untreated or poorly managed blood pressure. The common thread was almost always the same: They didn’t believe it could be them.
As a doctor, these encounters often leave me torn. On one hand, I respect people’s beliefs. On the other, I know how deadly this particular belief can be. It’s frustrating when people reject the science, but I’ve come to understand that people don’t trust what they don’t fully understand, and trust isn’t built in one visit.
Over time, I’ve learned that lecturing doesn’t work. Scare tactics don’t either. What helps is listening, asking questions, and slowly planting seeds. I’ve had patients who returned weeks later asking to “check again,” and gradually came around to treatment, not because I convinced them in one visit, but because I kept the door open and preserved the relationship.
I recall a woman who initially denied her diagnosis, but after several minutes of counseling, she changed her mind and agreed to start medication. Yet even after accepting the diagnosis, she began adjusting her doses without medical advice. I’ve noticed this pattern among patients with initial denial. They may reduce the dose, skip pills intermittently, or stop entirely for fear of “becoming dependent.”
In settings where beliefs run deep and resources are limited, we can’t afford to be judgmental or impatient. We must do well with empathy, cultural awareness, and long-term care. Otherwise, we lose people, not just to disease, but to misinformation and fear.
So when she stood up to leave that day, thanking me but still firmly rejecting the diagnosis, I didn’t argue. I simply handed her a card with her BP readings written on it, along with a gentle invitation:
“If you ever feel like checking again, I’ll be here.”
She looked at me, nodded, and tucked the card away. I don’t know if she’ll come back. But if she does, I’ll be ready, not just with my stethoscope, but with the patience and perspective I’ve learned over time.
Aminat O. Akintola is a physician in Nigeria.
