‘If you don’t prescribe it to me doctor, I’ll only buy it online,’ said the 58-year-old smoker this week, as she reached the pinnacle of her argument as to why I should continue to prescribe her hormone replacement therapy (HRT).
We’d long before talked through her age, the smoking, the fact she’d been on it the best part of 10 years, as well as the risk of venous thromboembolism and cancers – to which she responded: ‘It reduces the risk of colorectal cancer doctor, don’t you forget that.’ Thank God I’m still on 15-minute appointments.
For each well-researched and proven risk I explained to her, she had a counter-argument already lined up. It soon became obvious she had had these discussions every six months with GPs for the past five years.
She had, it appeared, what the RCGP would describe as ‘unusual health beliefs’. Apparently, stopping HRT makes you age 10 years almost instantly. It’s stress and poor quality food that cause cancer, not HRT. Not to mention that doctors don’t really know about these things, not really.
At what point do we simply say no, and tell her that, if she wants it, she needs to buy it online?
Well, I’m embarrassed to say after 15 minutes of circular arguments I signed the prescription, reasoning to myself she was over 18, of sound mind, and knows the risks – therefore it’s ultimately her decision. As she left, with a wily smile, my heart sunk low.
Why is it so hard to deny a patient that which they really want? It appears the decision to stop prescribing HRT to this patient has been postponed to a later date – I just hope she books in with a partner next time.
Julie Fry is a GPST3 in Cheltenham