Newsletter #2: Letting Some Patients Go



          It’s been a tough week for me. I am struggling with what to do with a few patients who are not making progress, and wondering if I am the right physician for these patients. Over the course of my career, I have found that when I finally came to realize that I am not helping a patient, the decision to end our professional relationship can only be described as agonizing.

This is not a decision I come to lightly, or abruptly. It starts as a niggling thought which grows and grows until I can no longer ignore it. I know that the recipient of these thoughts is likely to be deeply upset by this decision, some more than others. Some of these patients will have come to the same conclusion I have, sooner than I have. They will accept that they are not improving with my treatments and find another health care practitioner. Others will hang in there with me, despite their lack of progress.

When I share with them my concerns about their lack of progress, a common response is: “at least you care.” Well, I do, but perhaps caring is sometimes not enough. The old cliché that if you truly love someone you will let them go may apply here.

Personally, I find that coming to this realization is painful. Most health care providers can be described as “people pleasers” which is not always a healthy approach. Underneath the gentleness and kindness of wanting to make others happy, lurks the specter perfectionism, fear of failure and fear that the job won’t be done correctly and that the patient will be angry with us and criticize us for our failings. (Do I hear the distant echoes of dysfunctional relationships with our parents here?) Regardless of cause, and we can psychoanalyze it all we like, communicating to our patient that we have not met their needs AND realizing that we need to let them go in the hope that they will find someone else who can better meet their needs is difficult, very difficult.

If we can take a step back, however, it is, in the longer run often kinder and more helpful for everyone to allow our patient to move on. It’s a little like breaking up with someone you’ve dated for a while when you come to understand that this relationship isn’t going anywhere. The sooner you end that relationship, the sooner you both can go on to find a better match.

The decision to let a patient go doesn’t only affect me, but my entire medical staff as well. The patients I have not adequately helped usually take a greater percentage of my staff’s time and energy. Precisely because they are not improving, they are often needier and since those needs are not being met, everyone gets frustrated. Not meeting needs, for both patients and staff, is not a recipe for equanimity and ease of communication. As this increasingly dysfunctional relationship continues, with unmet needs increasing, emotions become more frayed for everyone and eventually it becomes clear that this is no longer conducive to healing.

I cannot speak to how this feels on the part of my patient, but on my side, after agonizing, praying and meditating over this, when I finally acknowledge to myself that I am not the right physician for this individual, it is with deep regret that I know that I have to send a letter informing my patient that I will no longer be providing them with medical care. I truly hope that they will find a health care provider more capable of helping them find a path to healing. Sometimes, caring is not enough. Sometimes you need to keep looking to find the right person to move forward and sometimes that person is not me.