How do you approach a treatment relationship with a patient who is non-adherent to recommendations and also is not interested in transfer to another practitioner?  

This situation superficially forces a provider to sit with frustration and perhaps resentment versus skirt the issue of abandonment. Some would (or would wish to) choose the latter and be ethically content to follow rules about providing referral information and a "buffer" period of continued care w...

There are some patients whom I decide I can no longer help. Not sure if this is one or not? But I’m a bit of a stickler when it comes to compliance. I might suggest to a patient that we’re not working together well, and solicit some suggestions from him or her as to how best to improve t...

In the changing world of medicine, we are moving away from the "doctor knows best" model to a shared decision-making model. When we work under the model that our patients have autonomy over their bodies and have the right to make decisions regarding whether or not to take medication (in all but our ...

I don’t believe a physician has to be “held hostage“ by a patient. There have to be rules and boundaries. It is not even a favor necessarily to the patient to continue along with the situation that is not productive. Termination of a relationship, so long as it is done compassionat...

I agree that treatment “contracts” can feel aggressive to the patient, but if done well and thoughtfully, it can presented as a way that the provider is making a commitment to the patient as well. A treatment contract provides a structure for the relationship to be more successful when a...

There are different reasons for this scenario. I think the psychodynamic approach can help understand: Why does the patient want to stay attached to me if they don't think what I suggest is reasonable or doable for them? Is there friction or passivity? Also, I have had a few cases over the years w...

There are parts of both of these approaches that are beneficial to the therapist and the patient. The contract approach brings the problems to the forefront and disrupts the heretofore unsuccessful behavioral pattern. However, limiting the patient to basically "sign or not sign" sidesteps the verbal...

What an interesting topic and so relevant as well! I can share some of the points made about the psychiatrist's duty, ethical concerns, liability, abandonment concerns, etc., but we are not talking about the patient's autonomy and ability to make decisions which is manifested at many points in the t...

If the patient is noncompliant, I pick a simple task that they are failing to do (e.g., clean up their room) if this is part of therapy. I suspend them (won't see them in therapy) until they can report that they have accomplished the task. I continue to prescribe medications for a few months.

I find this best dealt with via a goal-oriented treatment approach that is based on the patient's goals, not mine. Once they are clear about what improvements they hope for in their lives, we can discuss options about how to get there. They always have the choice about what options to pursue. If the...