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/.
KO Rural Mad As Hell Blog 
I’ve thought about this. I don’t think the analogy with a knee replacement works. REHAB from a knee replacement, maybe, since part of that is the job of the person, but the doctor? No.
You can recommend the best in the universe to an addict and it’s meaningless unless they are willing to suspend the complex range of, I dunno, issues? that go along with addiction among which is not really wanting help. A knee replacement is mechanical and likely to work, though sometimes it doesn’t. Therapy for an addict? It would be great if there were a mechanical fix for addiction. I’d have a brother right now.
From where I sit, your patient doesn’t want help.
They did initially but are half backing out.
I think it’s hard and scary. For my brother there was a period of optimistic euphoria and then the realization that it wasn’t going to happen overnight, he might fail, and it was easier to quit and get drunk. Well, he said as much. I’m sorry, Katy. I have a now-ex-friend who just made that circular journey back to substance abuse. The paradox is the person he hates most is me for having believed in him. It’s just the worst thing.
I’ve seen that optimistic euphoria a lot. Funny, but I was thinking that another group that resists are people in domestic violence relationships. I’ve found that sticking with them means that sometimes some of them will get out. Not all. Same with drug overuse. Really, none of get out of it alive in the end. I am sorry that you lost your brother and that your friend relapsed. I always hope they will try again, but a good many don’t make it.
I’ve been the abusee and it’s hard to break out. I wonder if anyone has ever studied whether the children of addicts — the sober child of addicts, the one who takes care of things — doesn’t often end up the victim of domestic violence. My therapist said, “Be uncomfortable is comfortable for you.” I hoped my friend would manage it, but it’s not my fault he didn’t. Alcoholic rage is one way the drunk can excuse his/her drinking. “I wouldn’t drink but you make me so angry.”
Oh well, Katy, it means the world to me that people like you with training still try and hope because sometimes it works — often it works. ❤️
Thank you! Still trying!
All the hugs in the universe headed your way.
Though your comparison has merit, modern medicine makes it hard to choose “the best” for any specialty. I tried to get an appointment with a hand surgeon I know and trust. After first going through my PCP for a referral even though the injury is already documents and imaged, I next have to see a PA to decide if I can actually see the surgeon, then I’ll have to convince them not to schedule me with whomever has the first opening or that the automated system tells them to schedule me with (which generally means the ones who practice in the new building they just built and have to pay for by booking fully). To the system, all of their doctors are good.
Yes, I totally agree. However you are trying to get the best, not avoiding them.
You are right about the distinction. But that might make it sadder – that it’s easier to avoid the best than get them.
Oh, I see spellcheck changed “”documented” to “documents” after I proofread. WiIl it do that again when I hit “send”, or do the quotation marks ensure it won’t try to correct me?
I think we are in a post Covid worsened physician shortage.