Dealing with Mistrustful Patients

Last week I met a delightful new patient. She brought in testing results and records from her previous physician. One of the tests indicated a medical condition for which medication was indicated. She had declined a prescription from her previous physician because she reported she didn't like to take pills. About five minutes later, we moved on to other topics and she pulled a medium sized bag onto her lap which was stuffed with bottles of pills.  However, these were all vitamins, minerals, herbals, and supplements so therefore not "medication" to her way of thinking.

These are the moments that make me wonder how Western medicine has failed our patients. How is that a physician with no financial ties to the company making the medication she is prescribing and for which there is strong scientific evidence of the medication's effectiveness is somehow suspect, while a purveyor of "herbal" or "natural" supplements that serves as its own evidence of benefit and who directly profits from the supplement's sale is trustworthy? Why do medications and immunizations that are often inexpensive (if generic) and which are often not only relatively safe but also effective, engender so much fear, suspicion, and misinformation?

I know that some of the bad press is related to media reports (and in the most unfortunate circumstances to misleading or false research published in medical journals) or anecdotal evidence from friends of friends. However, what makes a patient believe it? Why are some of the greatest advances in medicine in the last quarter century vilified?

Readers, as you may guess from my numerous questions, I just don't know. What I do know is that my more sophisticated and educated patients are among the worst offenders. Maybe all the education becomes paralyzing at a certain point. It is extremely rare that my less educated or "poorer" patients refuse immunizations for their children. Why, then, do equally caring and devoted parents who are more educated or have more resources consciously choose to skip one of the least expensive and most effective ways to protect their children?

My personal approach is a soft touch, although I know that some of my colleagues paint in vivid terms what could happen should a patient not get immunized or not take a medication as recommended. I still believe that medications, procedures, and vaccinations are all optional and should be ultimately decided upon by the patient. Unfortunately, my "informed consent" is often compromised by whoever has already talked to my patient about the possible problems associated with treatment.

I am uncertain how to bridge this gap other than with respectful conversation and relationship building. Honestly, though, that often does not work with my more recalcitrant patients. I am curious how other physicians address this.