I'd like to fire these patients, now please

I've upset 2 patients so far here in Burns, both last week and both for the same reason. One was morbidly obese, the other had very poorly controlled type 1 diabetes. Both refused to concede that their health problems (back and joint pain, shortness of breath in the obese woman; gastritis in the diabetic) were caused by their underlying co-morbid conditions, and they were both irritated that I told them they were.


So what do you do with such people as a physician, having taken that special oath to do whatever was in one's power to promote the health and wellbeing of one's patients? If I were a car mechanic I would simply say, "fine, Dave down the street may be willing to help you out instead."


Certainly, doctors "fire" patients, but this is typically for an ethical or personal issue that is irreconciliable and stands in the way of providing optimal health care. But in this case these patients were just being stubborn, not to mention foolish. And actually there was a third patient who insisted he get antibiotics for chronic sinusitis. It was not indicated in his case and he threw a hissy fit, insulting my attending, in the exam room (he was an unstable patient who had self-control issues, clearly). Actually I thought he might get belligerent. Most doctors would love to "fire" patients like these. Their personalities are toxic. They are hurting themselves and you are powerless to do anything. These are frustrating patients because there is no - or very little - hope that they will get better.