If you are going to have a knee replacement , you would try to choose the best surgeon, wouldn’t you? Yes. I am thinking of this because there is an illness where people often refuse the best. Not once but over and over.

I receive a card in clinic, a few days after a rather difficult day. Initially I don’t want to open it because it could be a yelling at me or threatening card. Hand delivered to our front desk. I open it and the card says what great care I give.

Wonderful, right? Except that there is a letter too, asking for a refill.

Most refills come through the pharmacy. Why a card and a letter? Have you guessed yet?

I call my patient. The patient was referred to the best addiction specialist in the area. The patient is not going to go to the specialist. The patient is not going to go to the group therapy, inpatient or outpatient. They can do this alone.

I let them know that I am not the local expert. I fail to change their mind. Yes, I will do a refill, but if they won’t see the expert, they have to come see me. Regularly.

This is typical for addiction. Denial and charm. A sweet card but trying to obscure that the patient is not going with the best treatment. I think of it as the drug or alcohol stil in control and whispering to the person: you are not really addicted, you don’t need anyone else, you can do it by yourself, we got this.

Chance of relapse? Well. I pretty much expect it. I would see this person monthly at least.

In what other illness do we refuse the expert, refuse help, refuse the best and say, I can do it alone?

For the Ragtag Daily Prompt: best: https://ragtagcommunity.wordpress.com/2025/06/29/rdp-sunday-best/.