As healthcare providers, we often encounter patients who have strong beliefs about their health and treatment options. Today’s case was a perfect example of how a balanced conversation and patience can lead to an unexpected, but positive, outcome.
The Patient’s Story
An elderly but otherwise independent and healthy gentleman presented with a basal cell carcinoma (BCC) on the lower eyelid. It had been growing slowly over the past one to two years and had reached a point where intervention was necessary. Given the tumor’s location, surgical resection was an option but came with significant morbidity, aesthetic concerns, and a potential risk of not achieving complete disease clearance. A multidisciplinary team, including dermatologists and surgeons, evaluated the case and concluded that drug therapy might be a reasonable alternative.
The Patient’s Initial Stance
Despite the logical medical approach, the patient was resistant to drug therapy. Instead, he had been taking selenium, believing through his own research that it would be an effective treatment. He had also experimented with vitamin D and vitamin E, ultimately deciding to continue selenium alone, based on a rationale that was not entirely clear. As a physician, I have heard so much misinformation and disinformation over the years that I no longer have the desire to argue or debate further; instead, I focus on ensuring patients have accurate information so they can make the best choices for themselves.
This is a scenario many healthcare providers are familiar with—patients exploring alternative treatments and sometimes resisting conventional medical approaches. I’ve had countless discussions about vitamins, marijuana, and even the controversial use of ivermectin in various conditions, including cancer. At this point, I half-expect a new, non-FDA indication or dis-indication for what ivermectin can supposedly treat—from infections to cancer, and even mechanical colonic obstruction. I kid not. Rather than dismissing his perspective outright, I allowed him to express his thoughts, giving him space to explain his reasoning.
The Approach to the Conversation
I always aim to provide patients with a clear understanding of their diagnosis, prognosis, and treatment options. In this case, I emphasized:
- The nature of his BCC
- Standard treatment approaches
- The potential risks and benefits of each option
- The possible consequences of doing nothing
I reassured him that the decision was entirely his and that my role was not to force treatment but to ensure he made an informed choice. However, I was slightly taken aback when he expressed concern that I was pushing medication on him—a common perception among patients when discussing conventional treatments. I am not holding these options in his hands or pockets, nor am I staring at him until he changes his mind—no. I place the options on the table. I do not need to wait for a decision to choose or not choose treatment. I will place the options on the table and respectfully move on to the next patient waiting for me. It is very simple and objective. When patients ask me direct questions about whether a cure is possible from blue scorpion venom or high-dose turmeric they found on an obscure internet site or what their distant cousin recommended, I look directly in their eyes and simply say, ‘No.’
The Power of Patient-Centered Care
As our conversation progressed, I assumed he would ultimately decline drug therapy and continue with his selenium regimen. But to my surprise, as I wrapped up the discussion, he suddenly asked, “So when do we start?”
This shift was unexpected, and I must admit I was confused if I had heard him correctly. I even asked him again if he meant to pursue observation alone with his “vitamin” regimen. Wow.. I did not see that coming however to me it reinforced the importance of:
- Listening to patients – Giving them space to share their concerns and perspectives.
- Providing clear, factual information – Ensuring they understand their diagnosis and all available options.
- Respecting patient autonomy – Allowing them to arrive at their own decisions without feeling coerced.
Broader Lessons for Healthcare Providers
This case mirrors many encounters I’ve had, from cancer patients to those hesitant about vaccines. A similar situation arose during the COVID-19 pandemic when many individuals initially refused the vaccine but later changed their minds when loved ones had passed — and unfortunately sometimes too late in the ICU. Yes. It is your body and your right to refuse treatment and no healthcare provider should feel bad about that. It may also be your best chance for a cure, but if you decline it… I will not and cannot carry that burden. I had broke that rule once.
I recall a heartbreaking case of a young woman with high-grade extremity sarcoma. She was previously young and healthy, a college student with her entire life ahead of her. Yet, both she and her parents declined what was likely her best chance for cure, leaving it to faith. This was one of the rare instances where I found myself almost begging them to reconsider, to at least seek another opinion at another center, hoping someone else might reach them where I could not.
I am a proponent of faith in the unseen—I will take every bit of help I can get. But this reminds me of the old parable: A person stranded in life-threatening waters prayed for God to save them. First, a boat came by, and they refused help, saying God would rescue them. Then a helicopter, then another boat—each time, they declined. When they drowned and met God, they asked, “Why didn’t You save me?” God simply replied, “I sent you a boat, a helicopter, and another boat—why didn’t you take them?”
Faith is not the absence of action. The consequences of their decision were devastating, and by the time they returned to clinic 5-6 months later, the disease had progressed to an incurable stage.
The Role of Documentation and Communication
As medical professionals, it’s critical to:
- Document discussions thoroughly, including when patients choose alternative options. Patients may decline and suffer a fatal outcome, however the family and attorneys may see the situation differently without clear documentation.
- Encourage second opinions when patients are hesitant or resistant.
- Respect patient autonomy while ensuring they understand the potential outcomes of their decisions.
Final Thoughts
This case was a powerful reminder that even when a conversation seems to be heading toward patient refusal, there is still room for change. Keeping discussions open, nonjudgmental, and educational can lead to better outcomes for patients… or it may not and we will have to accept that.
For healthcare providers, these cases can be frustrating and even contribute to burnout, particularly when faced with misinformation or resistance. However, by maintaining empathy, patience, and professionalism, we can continue to guide patients toward the best possible decisions for their health.
At the end of the day, informed decision-making remains the cornerstone of good medicine. We provide the information, but the power ultimately lies in the patient’s hands.
About the author
Dr. Sajeve Thomas is a distinguished medical professional and a compassionate guide in the field of oncology. With over a decade of dedicated experience as a board-certified medical oncologist/internal medicine specialist, Dr. Thomas has become a trusted expert in the treatment of melanoma, sarcoma, and gastrointestinal conditions. He brings a wealth of expertise to the complex and challenging world of oncology.
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