When we are in school, we are trained in many different treatment modalities. We are given first line, second line, and third line treatments, and go through endless clinical scenarios. We are taught the pathophysiology of medications, when to order imaging studies and when to refer to a specialist. We are given more information than we could hope to process, let alone memorize, and then told that this is just the ‘tip of the iceberg.’ The majority of providers are perfectionists, and nearly all of us are high-achievers. We expect the best from ourselves, and want the best for our patients. 
But something changes when we go from learning in the classroom to practicing in the world. We realize that even the most solid academic background cannot ‘cure’ every patient. We are faced with the reality that patients are not textbook ‘case studies’ but human beings, with their own free will, and living within their own unique set of circumstances. 
Patients may come to the doctor with the best of intention to ‘take care of their diabetes’ or ‘get their heart checked out.’ However, they may not understand the depth of what that may entail. For example, a patient may not be ready to start taking insulin every day, carefully checking his blood sugar, and radically overhauling his diet. Another patient may not have the money to pay for an echocardiogram, or even to a see a cardiologist. We make referrals, order tests and imaging, and write prescriptions, and instruct our patients on what we deem to be the best care plan for them. But many of these prescriptions will never be filled, and many patients will not follow up with a specialist or go for that routine colonoscopy we recommended. 
It is too easy to put the onus on the patient and say they are ‘non-compliant.’ However, the situation is more complex than that. There are financial constraints at play, family responsibilities, the fear of invasive procedures or taking a new medication, and even simple barriers like reliable transportation or childcare.
We as providers work within a larger healthcare system, but we also work within a larger society, which comes with its own set of challenges and barriers, both for us and for our patients. It is easy to become frustrated when you see that patients are not ‘getting better’ or are not following through on our recommended treatment plans. But I think that meeting a patient where they are at, and having honest conversations with them about what they are able and willing to do, will go a long way to improving outcomes. 
Sometimes the most we can do is to meet patients where they are, and to walk with them along their journey of life, as well as health. We are joining with our patients to help them as well as we can, in whatever way they allow us to help, and that in itself is.

Erica Chustz PA-C 

Erica has been an APPAA contributor since 2020. Since graduating in 2018 from UNT Health Science Center, she has been working in psychiatry.