When patients do not follow your advice

• Patients have the right to make decisions about their treatment, including refusing treatment. 
• Help a patient make an informed choice by understanding their situation and providing patient-friendly information and support.  
• If a patient chooses to act against your advice, determine the best way forward for the therapeutic relationship. 

At some stage in your career, you will encounter a patient who doesn’t want to follow your recommended treatment. This may be through inaction, such as a patient who doesn’t turn up for a test or take their medication, or a patient choosing a treatment you believe is of no benefit or may even be harmful, such as an alternative or untested treatment or supplement.  

A patient with decision-making capacity has the right to refuse treatment. This can clash with your legal and ethical obligation to act in a patient’s best interests and to exercise reasonable care and skill in the provision of medical advice and treatment.  

Each patient situation requires an individual approach and balanced judgement. These strategies outlined here can help you navigate these challenging scenarios when they arise. 

The principle of patient autonomy means it is always the patient’s choice to accept or continue treatment, as long as they have relevant decision-making capacity. Your role is to provide all the information they need to make an informed decision. Make sure the information is patient-friendly – explain terms they may not know and limit the use of medical jargon. 

If you are concerned a patient will not follow your advice:  

• reiterate your recommendation  
• explain the potential risks and benefits for your recommended treatment  
• outline any reasonable alternative management plans you’re prepared to support  
• explain why you consider your recommended plan is preferable  
• discuss the risks and implications of not complying with the recommended treatment. 

At the end of the consultation, set the expectation for what you would like the patient to do. Be clear and avoid any vague or ambiguous terms.  

Explore the reasons behind non-compliance 

There are many reasons why a patient may refuse or not follow a recommended treatment. Understanding what lies behind their decision may allow you to reassure the patient and help them make an informed choice.  

For instance, a patient who repeatedly does not turn up for a diagnostic test may tell you it’s because they’re too busy. However, if you explore more deeply, you may discover they don’t understand the significance of what they may be facing or may fear the result of the test.  

Sometimes, patients are simply overwhelmed by the enormity or complexity of their condition and/or treatment. Breaking it into small steps and explaining what to expect at each stage, may encourage the patient to agree to a preliminary stage before making further decisions. 

Respectfully implore a patient to act on your advice 

Patient-centred care and respect for patient autonomy still allows you to attempt to influence a patient to accept your advice.  

Listen to the patient, empathetically explore their concerns and put forward your own concerns. Don’t be afraid to be direct but always remain respectful of the patient and their views. For instance, you could say “I’m concerned that if you don’t do X now, Y might happen" or explain why you don’t believe the patient’s preferred treatment will benefit them or may harm them. 

To persuade a patient to reconsider their options you could:  

• ask them to return for another appointment after they’ve had time to think things over  
• supply further information for the patient to take away and read 
• advise them to seek a second opinion.  

Ask the patient if they would like to you to discuss your concerns with their family members. A collaborative approach to treatment can provide better care and support for a patient. However, disagreeing with a patient’s choice is not a reason to breach their privacy and confidentiality, so don’t talk to their family without their consent.  

While decisions about treatment rests with the patient, you have a duty to provide views and recommendations based on best medical practice. You have a professional obligation to act in the best interests of your patient and focus on their wellbeing.  

Decide what to do about a patient’s non-compliance  

After providing a patient with your advice, it is their call whether to follow it. You may not agree with their decision but you should strive to maintain your therapeutic relationship with them. You could ask the patient to come back and see you again, for example "I would like you to come back and see me in xx days/weeks/months".  

Depending on your perception of the patient’s non-compliance and the possible harms that may result, you may decline to treat the patient or refer them to another doctor who may better engage with them.  

Ending the doctor–patient relationship 

Carefully consider whether it’s necessary and appropriate to terminate your therapeutic relationship with a patient.  

It is never ideal and almost never appropriate to terminate the therapeutic relationship during an acute illness or where there is no reasonable alternative for the patient’s ongoing care. You are always required to act in an emergency even if you have formally ended your relationship with a patient.  

Before terminating a doctor–patient relationship, consider discussing it with senior colleagues or Avant. Further information is available in our factsheet How to end the doctor–patient relationship. 

Good documentation is essential when there is difference between your views and those of a patient, or when a patient decides not to act on your advice.  

Document your discussions with the patient, concerns you and they expressed, advice given, risks discussed and information provided. Clearly record your advice to the patient and the discussions you had with them about the implications of their choices.  

No two situations are the same, just as no two patients are the same. Negotiating the best care for a patient and deciding how to manage a patient who acts against advice requires your professional judgement on an individual case basis. When navigating these difficult situations it is highly advisable to seek the support of colleagues or Avant.  

Medical Board of Australia Good medical practice: a code of conduct for doctors in Australia  

Avant factsheet Capacity: the essentials 

For medico-legal advice, please contact us here, or call 1800 128 268, 24/7 in emergencies.