The Ups and Downs of Doctoring

Being a doctor can be incredibly rewarding. At the free clinic where I work as a Spanish medical translator, I have seen some of those rewards - hypertensive patients whose once-elevated blood pressure comes down to a normal range, or diabetic patients whose blood glucose levels are finally controlled after months of trying to find the right combination of medications.

But being a doctor can be incredibly frustrating, too. I was a witness to that this week during one of my translating sessions.

A patient came in with very uncontrolled diabetes, and a hemoglobin A1C (a test that measures blood sugar levels across three months' time) of above 12. For diabetic patients, you try to get that level to somewhere around 7, so this level was not good. Not good at all. The patient had been taking a combination of pills to treat the diabetes, but clearly that was not enough. So the doctor said it was time to start insulin. The patient balked, and asked whether there were any other pills, any other methods, they could try. The patient promised to eat better, to exercise more. But there was no way to come down from that high of a hemoglobin A1C level without insulin, the doctor explained. Insulin was necessary at this point.

But the patient would have none of it, even when the doctor explained all of the possible effects of maintaining a high blood sugar level for a long period of time - eye problems that can lead to blindness, kidney dysfunction that can lead to dialysis, persistent infections, higher stroke risk, heart issues, extremity amputations.

As I was translating, I tried to think of the situation from the patient's perspective. Having to inject yourself with medication every day, probably for the rest of your life, is a scary prospect. No one wants to have to do that. On the other hand, all those diabetic complications are terrifying. I found it difficult to understand why someone wouldn't want to do everything possible to prevent them, even if it meant a daily injection. But as a translator, I am an intermediary, a conduit, so I kept my own thoughts out of things.

Clearly, the physician was frustrated too. She was doing her best to provide the best care she could, and the patient was refusing to do what was necessary to maintain a healthy body. Although the doctor tried her hardest to persuade the patient, the patient continued to refuse the insulin. And the patient had the right to make that choice.

I hope the patient has a change of heart and decides to take the insulin, I really do. I know the doctor I was working with does, too. But in the end, I think that as a physician, you have to realize that you can't fix everything. You can't force anyone to do something they don't want to do, no matter how beneficial it might be for them. So at some point, you have to let it go. That's not to say you don't revisit the issue on a future visit. No, I think doing that is entirely appropriate. Maybe eventually, the patient will change their mind. What I mean is that people will make their own choices, and sometimes there is nothing you as a physician can do, regardless of all your knowledge and education and degrees, about those choices. Do you stop caring? No, certainly not. But I think you have to guard against internalizing such situations and taking them personally. And while you do that, try to maintain a glimmer of hope that maybe, next time, they will come around.