People Don’t Always Make a Lot of Sense

Doctors can't count on patients to act in their own best interest.

Posted Jun 17, 2015

Devin presented me with a strange rash. As a mid-20’s accountant at a large national firm, he showed me an eruption of purplish spots all over his body.

“I was visiting family in Grand Rapids,” he said, “and a local dermatologist gave me the diagnosis.” Devin named an exotic disease I have never seen in person. His rash did not resemble what that condition is supposed to look like.

“Did the doctor do a skin biopsy?” I asked.

“No,” said Devin. “He just gave me these pills.” He produced a bottle of a fairly heavy-duty drug with potential major side-effects.

“I’d better do a skin biopsy,” I said. “I’ll call in a few days to let you know whether you should stay on this medicine or we should make a change.”

When I got the results four days later, I left a message for Devin asking him to call me. Getting no response, I left another message three days later. Still nothing. The next week I called again. An uncertain male voice answered. “Does Devin live here?” I asked. He didn’t seem to know.

Maybe I had the wrong number. I didn’t have Devin’s e-mail address, so I sent him a letter (the old-fashioned kind, with an envelope and a stamp). No response.

I tried to make sense of this. Had Devin’s rash just cleared up? Had he become seriously ill and been hospitalized? Had he been dissatisfied with my advice and gone elsewhere? (But even so, wouldn’t his new doctor have wanted to see my biopsy report?)

A full month after I met him, Devin e-mailed me through my website.

“Hi, this is Devin. Could I get my test results?” He left his number—the same one I’d been calling.

He answered. “Hello, Devin,” I said.” “Did you get any of my calls?” He hadn’t, telling me that his voice mail had recorded “no missed calls.” Had he gotten my letter? He had not.  “Is your address 1156 Boston Boulevard, Apartment 65E?” Yes, that was correct. No, no letters came.

“So how about my results, Doc?”

“They didn’t show the diagnosis the Michigan doctor gave you,” I said. “You can stop the pills now.”

“Oh, I stopped them last month.”

“You did? OK, but how come?”

“I don’t know. I just stopped them. I was going scuba diving in Ecuador. Was that OK, being in the sun and all?”

“Any chance I could have a look at you?”

“Sure,” Devin said. “The rash seems to be getting better.”

When I saw him a few days later, his rash had almost completely faded. I told him what I thought the diagnosis actually was, said there was nothing to do for it now but to call me if it ever came back.

Did Devin explain why he’d been unreachable? Elaborate on why he stopped the pills? Did he make any reference to my efforts to call and write, or to the delay in getting the diagnosis? He did not.

Devin is an educated professional in a responsible job. Does his behavior make any sense? Not much.

And yet there is Devin, right in front of us. We have to take him as he is.

 Used With Permission
Source: Istock: Used With Permission

I spent time discussing Devin with the medical student working with me during this episode. She was as perplexed as I.

“I don’t have much wisdom to share,” I told her, “except for this: 

“You will be taking care of patients. People often don’t make sense, when it comes to their health and to a lot of other aspects of human behavior. You just have to be prepared for this. And you can’t take for granted that people will act in their own best interests.

“This is true even when doctors speak clearly and slowly, when there is no language or cultural gap, when there is—to put it simply—no reason for them to act this way.

“Most of the time, their health problem goes away by itself or is not that serious, so they get away with things. But when the stakes are higher, it is our responsibility to chase after patients and encourage them to do the right thing. We can’t excuse laziness by shrugging, ‘Well, they are autonomous adults. It’s their job to follow through.’

"That’s not good enough. We have to do what it takes, up to and including chasing them down. As Devin illustrates, we don’t always succeed. But we have to try.”