It was 5 pm on a Friday, and Dr. P was looking forward to a relaxing weekend – he had just one patient left to see. Normally, Dr. P, 57, a sole practitioner with his own small office would not schedule a patient appointment for 5 pm on a Friday, but this patient was extremely unreliable, and there was as good a chance that he wouldn’t show up as there was that he would.
The patient, Mr. M, was a 61-year old African-American man with poorly controlled high cholesterol and diabetes. The poor control was not due to anything that Dr. P had failed to do – he had, for the past 5 years of seeing this patient, explained to him repeatedly the importance and necessity of taking the medications as prescribed, and returning for scheduled medical appointments. Yet the patient continually missed half his appointments, and was noncompliant with his statin and his diabetes medications. Dr. P had warned the patient that as he got older, his risks for cardiovascular issues would just increase, particularly since he had been gaining weight and his blood pressure had been borderline high on the last two visits. He would give the patient the best advice that he could – “take your medications as prescribed, show up for your appointments, lose some weight, stop smoking, eat healthier food, get some exercise…” – but Mr. M just did what he wanted.
The physician peered into the waiting room and was surprised to see the patient there. He’d missed his last appointment, which was par for the course. Dr. P ushered the patient in, and began a physical exam while asking Mr. M some questions.
“So, have you given up smoking yet?” asked the physician. “You know that would reduce all sorts of other risks.”
“Sorry Doc,” said the patient, with a wry half-smile. “I got a lot of stress. Starting a new job Monday. Not a great time to stop smoking. But maybe once things calm down a little…”
“What about your medications,” asked the doctor. “Have you been taking them when you are supposed to?”
The patient shrugged. “I try, Doc, I try,” he said, “but it’s hard to remember every day.”
“Some of them are more than once a day,” the physician reminded the patient.
“I guess I forget some of the time,” said Mr. M, nonchalantly.