“We’ve discussed this many times,” said Dr. P to the patient. “Remember, I suggested that you get those pill holders with the days of the week on them to help remind you.”

“Yeah, I didn’t get one yet. One of these days,” said the patient.

Dr. P continued his exam as he listed again for the patient the many reasons why it was important, no, vital, to take his medications. As usual, he felt that his message was being ignored. The patient, he noted in the chart, had gained some weight and was verging on obese. His previous borderline blood pressure was now up to 150/85mm/Hg. At his last appointment, a year ago, it had been 138/80. Were it any other patient, Dr. P would now have prescribed a blood pressure lowering medication, but he felt that it would be pointless in this case considering that the patient was non-compliant with his other medications.

He informed the patient that his blood pressure was high but that rather than put him on another medication immediately he would schedule a follow up appointment in one month for another check of the blood pressure. “You may end up needing medication for that too,” the doctor warned the patient, “but if you’re not taking your medications, they are not going to work.”

The patient nodded and began to walk out of the office. “Good luck on your new job,” called Dr. P to the patient as he left.

Unfortunately, Mr. M would never make it to his job on Monday. On Sunday, two days after his appointment with Dr. P, the patient suffered a massive ischemic stroke involving several blocked cerebral arteries. Although he was rushed to the hospital, it was too late to salvage damaged brain tissue and Mr. M was left with significant brain injury and no function in either leg or his right arm. A lawsuit was filed on Mr. M’s behalf against Dr. P.

The physician explained everything to his defense attorney, including the fact that the patient was noncompliant with his medications and his medical appointments, and that it seemed pointless to prescribe yet another medication that wouldn’t be taken.