The Provocative (and Non-Compliant) ESRD Patient

Physicians learn early in their careers how to cope with reluctant, uninformed and frightened patients. Active resistance and combative behavior, by contrast, is unsettling, at the least, and sometimes provokes despair, anger and hostility in care givers. For patients with end-stage renal disease (ESRD), creating an atmosphere of antagonism and conflict that transforms therapy into conflict that may defeat the physician's primary obligation to beneficence. Faced with a belligerent, threatening and law-suit-minded patient who frustrates efforts to proffer ordinary treatment, the sometimes bewildered nephrologist seeks to break the patient-physician bond by any legitimate means. Consider the following example: