Each day I go to work, I look forward to seeing return patients, to hear how they have faired or to see what is bothering them now. I aim to hone my skills in long-term follow-up care. I especially enjoy patients whose families I have treated off over the last 40 years. Children have been born and raised, relationships have evolved, and people have weathered the ups and downs of life.

I also happily anticipate the one or two new patients I meet each day. A new patient offers a fresh start with someone I do not know, with their unique combination of complaints and personality, giving me a chance to stretch my diagnostic and social skills.

The practice of naturopathic medicine appeals to me for many reasons, with its logical and elegant philosophy, its emphasis on preventive, whole person care and by offering me the opportunity for compeling and gratifying work. I imagine this last sentiment is true for most any kind of physician. I love my job. That said, there is the occasional patient, who for one of a number of reasons, I decide I should not treat. Because I am in private practice, I have this liberty, which understandably, many of my colleagues across the medical landscape, do not.

These patients fall into several categories:

1. Patients with unrealistic expectations.
2. Patients who are unwilling to work together with allied health care providers.
3. Adult patients who are brought in unwillingly and who are not compliant.
4. Adult patients who are belligerent or violent to members of my staff or me, either in person, by email, or by phone.
5. Patients who have complaints which I feel naturopathic medicine cannot address.
6. Patient who would be better served by a colleague with different skills and experience.

Patients with impractical expectations are those that want permanent cures for problems there may not be cures for. They may have timelines as to when their fill in the blank, will be better. My staff is good at communicating general information on such topics before patients come in.

There is not a diagnostic grouping that I flat out turn away; in fact, for a good number of genetic, tragic, incurable, or terminal patients, there is still much that conventional and natural medicine can offer, from pain reduction, to psychological help to comfort care. We can help support the overall health of the patient by addressing physical symptoms and help to uplift spirits and support mental faculties. We can sometimes help with sleep and energy level and with side effects of other treatments.

I will deny services to patients who are rigidly against the use of conventional medicine. As I tell patients, there is a time and a place for all sorts of medical approaches and sometimes that means using pharmaceutical prescriptions or a recommendation for a surgical consultation. Because I see as my highest calling, to help the sick, there is little I will not consider to help my patients feel better. Trained and practicing as a naturopathic physician, these are not the first approaches I might work with, but I want and want my patient to consider all their options.

For adult patients dragged in unwillingly by concerned partners, parents or friends, I generally do not offer care. There are too many complicating factors. Though the person who brought them is likely well-intentioned, it will be difficult to obtain a good enough patient history, conduct a relevant physical exam. How I will be able to attain appropriate follow-up care? I offer educational materials to inform the patient in question and express my sincere willingness to treat that person when they are ready to be treated.

You may wonder about adults suffering from an intellectual disability or a mental/emotional illnesses, or cognitive decline, who are unable to make health care choice decisions on their own. In such a case, I defer to the legal guardians and we work as well as we can.

As to those adult patients who are exceedingly rude or aggressive or abusive to myself or my staff, we discontinue treatment. We need to keep ourselves and other patients in the office safe. It is true that such patients could most certainly benefit from treatment and care, but at this point in my practice, this is a policy we stand by.

Occasionally, I receive a patient who wants help for something I cannot help with. For instance, I once had a patient who wanted a cure for male pattern baldness — ah, if only we had a cure for that! Another person presented with a scattering of benign nevi (beauty marks) on her arms. She wanted a natural remedy to get rid of what she considered blemishes. If I were to take the complete medical history of such a patient, I could create a plan to address other issues, perhaps digestive irregularities, or a mild acne, or maybe underlying anxiety. But I must tell the patient that I cannot help the complaint they are in for. It would be up to them to decide if they wanted more general care.

Suffice it to say, these categories do not represent hard and fast rules; I have taken on all manner of patients described in this article at one time or another and do the best work I can. I continue to learn about my own capacity and limitations.

I have turned away patients at the time they contact the office for any of the above reasons. But sometimes I do not know, for the better part of the initial consultation, that I am unable to take a patient into the practice. Once I arrive at that understanding, I am as forthcoming as possible, as soon as I know. I never charge for such an interview, and I always chart my decision accurately. I may refer to another provider whose work is more in line with this patient’s need.

It’s also true that many of the people I have turned away over the years, have become a dedicated source of referrals. There is a respect developed, even without helping them as a doctor. It’s like the wondeful holiday movie, Miracle on 34th Street, where a shopper at Macy’s did not find the gift she was after. A worker there sent her to another store, which was at first frowned upon, but in the end worked out well for Macy’s!

I hope other health care workers will consider this topic and remind practitioners that though we must attempt to help all patients we agree to treat, it is okay to turn away a patient before they have been seen, or even after an initial intake, in fact, it is sometimes in the patient’s best interest.

With so many patients to care for, I believe it is essential not to take into the practice the rare patient who falls in to one of the above-mentioned categories. No one can help everyone, and knowing our own limitations, as well as our own strengths, enables us to offer our help and expertise to those we can.