Skip to main content

Informed Consent: The Right to Refuse Medical Treatment

There are some patients we doctors never forget. They linger in our memories for various reasons. Often, it is their serious or unusual medical condition that stays with us. On other occasions, it is a zany or unique personality that we recall, even years later. Rarely, when the doctor-patient relationship becomes injured, then the patient may become unforgettable.

I remember a particular patient from 20 years ago for a very different reason. I recall him clearly because he rejected my medical advice to him with aplomb. Although I haven’t seen him for two decades, I will never forget him. He taught me a lesson, which is not surprising since patients are our best teachers. There are no CME credits for these lessons, but I’ve learned more from them than I have at many medical conferences or from medical journals.

It was July 1991, a month after I completed my fellowship in gastroenterology. I had jointed a multispecialty group, and I was the only gastroenterologist in this particular site of the clinic. There was no senior gastroenterologist to supervise me. What a comfort it was during fellowship training to have seasoned clinicians nod affirmatively to my diagnostic plan, or point out what I overlooked. To this day, I wish I had one of these master clinicians sitting quietly in the back corner of my exam rooms to mentor me. In July 1991, I was now responsible for my own advice. Despite excellent training, I was anxious that it was my finger on the trigger.

I performed a screening colonoscopy on this man and discovered a large, flat lesion in the upper part of the large intestine. A biopsy indicated that this was a pre-cancerous polyp, although it was possible that there was cancer present that was not sampled by my biopsy instrument. (Biopsies only obtain tiny pieces of tissue, which may not be representative of the entire lesion. Physicians call this phenomenon sampling error.)

This concerning lesion could not be removed with the scope, so I recommended that he consult with a surgeon to discuss an operation. He listened and calmly declined my advice. More accurately, he offered a conditional decline. He stated that he would see the surgeon, but not until 4 months had passed. This was unexpected as most patients want their surgeries to occur yesterday. The patient made clear that there was no earthly force that would alter his decision. This mystery entered the theater of the absurd when I learned his reason for the delay. Here are some choices. Take your best guess.

  • He and his family were about to leave on a 4 month cruise.
  • November was his lucky month and he wanted surgery then.
  • It was golf season, which was sacred.
  • His medical insurance coverage would become active November 1st.
  • He intended to travel to Mexico for alternative medical care.
I surmise that most readers did not select the correct answer. This man was a golf fanatic, and even the possibility that he harbored a colon cancer, would not coax him off the fairways. Interesting priorities. We physicians need to remind ourselves that patients make the decisions, even though we often believe that we have the right answers.

The denouement? Months later, he underwent surgery and a large benign lesion was removed. I think I was more relieved than he was.
If this guy’s appendix or gallbladder were to go bad, I hope it happens during wintertime. Surgery can occur in any season. But, golf…


  1. Better lucky than good. Sometimes patients make good decisions for themselves, but not always.

  2. @Plastic Doc, agree. This patient used poor judgement, in my view, and dodged a missile. My point remains that it is his choice to make. Thanks for the ocmment.

  3. Hi, MD Whistleblower. It's my first time to read your blog. Very nice post. I can still remember when I was having my duty in the hospital. Some patients were really not cooperative and wouldn't follow their doctor's advice.But, patients have the right to refuse treatment.Hehe! I will surely read your other posts. :)

  4. Suji, welcome to the blog! Look forward to your stopping by again. You don't have to follow bloggers' advice either!


Post a Comment

Popular posts from this blog

Why Most Doctors Choose Employment

Increasingly, physicians today are employed and most of them willingly so.  The advantages of this employment model, which I will highlight below, appeal to the current and emerging generations of physicians and medical professionals.  In addition, the alternatives to direct employment are scarce, although they do exist.  Private practice gastroenterology practices in Cleveland, for example, are increasingly rare sightings.  Another practice model is gaining ground rapidly on the medical landscape.   Private equity (PE) firms have   been purchasing medical practices who are in need of capital and management oversight.   PE can provide services efficiently as they may be serving multiple practices and have economies of scale.   While these physicians technically have authority over all medical decisions, the PE partners can exert behavioral influences on physicians which can be ethically problematic. For example, if the PE folks reduce non-medical overhead, this may very directly affe

Should Doctors Wear White Coats?

Many professions can be easily identified by their uniforms or state of dress. Consider how easy it is for us to identify a policeman, a judge, a baseball player, a housekeeper, a chef, or a soldier.  There must be a reason why so many professions require a uniform.  Presumably, it is to create team spirit among colleagues and to communicate a message to the clientele.  It certainly doesn’t enhance professional performance.  For instance, do we think if a judge ditches the robe and is wearing jeans and a T-shirt, that he or she cannot issue sage rulings?  If members of a baseball team showed up dressed in comfortable street clothes, would they commit more errors or achieve fewer hits?  The medical profession for most of its existence has had its own uniform.   Male doctors donned a shirt and tie and all doctors wore the iconic white coat.   The stated reason was that this created an aura of professionalism that inspired confidence in patients and their families.   Indeed, even today

Electronic Medical Records vs Physicians: Not a Fair Fight!

Each work day, I enter the chamber of horrors also known as the electronic medical record (EMR).  I’ve endured several versions of this torture over the years, monstrosities that were designed more to appeal to the needs of billers and coders than physicians. Make sense? I will admit that my current EMR, called Epic, is more physician-friendly than prior competitors, but it remains a formidable adversary.  And it’s not a fair fight.  You might be a great chess player, but odds are that you will not vanquish a computer adversary armed with artificial intelligence. I have a competitive advantage over many other physician contestants in the battle of Man vs Machine.   I can type well and can do so while maintaining eye contact with the patient.   You must think I am a magician or a savant.   While this may be true, the birth of my advanced digital skills started decades ago.   (As an aside, digital competence is essential for gastroenterologists.) During college, I worked as a secretary