Why Patients Refuse to Follow Medical Advice: Avoiding a Power Struggle

Understanding the Choice Theory in Patient Care and Beyond

Every parent knows the moment: you tell your teenager to clean their room, and suddenly that room becomes a fortress of defiance. You tell your partner they "need" to exercise more and watch them dig in their heels. This isn't stubbornness—it's human nature. When we feel our autonomy threatened, we instinctively push back. It becomes a power struggle, and power struggles have no winners.

This same dynamic plays out every day in healthcare settings not only in Missouri and Tennessee, but nationwide. A diabetic patient refuses to check their blood sugar. A cardiac patient won't take their medications. A patient with sleep apnea leaves their CPAP machine in the box. Healthcare professionals, trained to heal and advocate, find themselves in an exhausting push-pull that leaves everyone frustrated.

Understanding why patients refuse to follow medical advice can help avoid a power struggle while offering potentially better options. As both a former critical care nurse and a current conflict management specialist, I've learned that this tension isn't really about the behavior we're trying to change. It's about something deeper: the fundamental human need for choice and control over our own lives and often the issues that lay underneath.

The Power Struggle: Where Healthcare Accountability Meets Patient Autonomy

Here's a fundamental principle I use in mediation that also applies to anyone who serves others: we're not over people, we're with them. While we may know what will likely be the best treatment, we ultimately don't know what's best for someone else in the big picture. Yet we can be present with them and help them get all the information they need to make those big decisions. Ultimately though, it's their life, their choice, and their consequences.

After years in both critical care nursing and conflict management, I've learned that one of the hardest skills for healthcare professionals to master is recognizing where our accountability ends and patient autonomy begins. We're trained to fix, to heal, to advocate, but sometimes that drive to help becomes a push that makes patients push right back. Maybe we should fix, heal (when possible) and educate more than advocate.

The truth is, we can't want someone's health more than they want it themselves. Our job is to make sure they truly understand the consequences of their choices, to give as much information as possible, to offer a path for them to change their mind, to answer their questions as completely as possible, and to document thoroughly. But the choice? That belongs to them, not us.

Understanding What's Really Happening: Fear, Loss, and Underlying Needs

Often underlying needs keep patients from complying. We need to find out why it's hard. What are they afraid they'll lose?

For many patients, the behavior change we're requesting isn't just about willpower or knowledge, it's about identity, loss, and fear. That person who won't change their diet? Food might be their last source of comfort or connection to their culture. The patient who refuses to use a walker? They may be terrified of becoming "old" or dependent. The person who won't take their medications? Perhaps they're already taking twelve other pills and this feels like one more piece of themselves they're losing to illness.

Different people prioritize different values. What feels like life-or-death urgency to us might rank much lower on their priority list given everything else they're managing. That doesn't make them wrong; it makes them human. People often see the thing we're asking them to change as the same thing that gives their life quality. And for many people, this is their truth.

When we approach these conversations with only two options -either do or don't do -rather than values to understand, we miss the opportunity to truly connect with what matters to the patient. We miss the chance to find creative solutions that honor both medical necessity and human reality.

"No" Often Means "Not Yet." So, Don't Take It Personally

Here's something crucial that healthcare professionals need to remember-when patients say "no," it's not necessarily final.  It's often "not yet," "I'm scared," "I don't understand enough to say yes," “I’m overwhelmed and trying to put this into manageable steps,” or "I need time to think about this." People very often say “no” first before we even begin to think how we might; our first reaction is often that we can’t. We can't take that personally.

Responding with "I hear that for now you don't want to try the medication" does something powerful. It acknowledges their autonomy while leaving space for them to reconsider without losing face or admitting they were "wrong." It keeps the conversation open without creating pressure.

This simple reframe, (one of my favorites) "for now" recognizes that decisions aren't always permanent and people need space to process, to grieve what they're losing, and to come to their own conclusions in their own time.

Finding the Third Option: Moving Beyond Compliance vs. Non-Compliance

This is where conflict management skills truly transform healthcare practice. As mediators know, the best solutions often exist outside the binary choice. If patients can't do what medicine shows to be best practice, is there something else they can do instead?

Instead of walking away after hearing "no" or continuing to push the same recommendation, skilled healthcare professionals ask:

• "What would you be willing to try?"

• "Would you be willing to try this for two weeks and then we reassess together?"

• "Is there a smaller version of this change that feels doable right now?"

• "What would you need from me or your support system to make this work?"

• "Is there a different approach entirely that might get us to a similar outcome?"

  
  

This isn't lowering standards or abandoning evidence-based practice. It's recognizing that a patient who tries a modified approach is infinitely better off than a patient who refuses everything because the ask felt too big, too fast, or too disconnected from their reality.

A patient who won't take four new medications might agree to start with one. A patient who refuses to "exercise" might be willing to park farther from the store entrance. A patient who won't give up their cultural foods entirely might work with you to modify portions or preparation methods.

This is where the healthcare professional's expertise and the patient's autonomy work together instead of against each other. It shifts from "my way or your way" to "let's find a third way that honors both the medical reality and your lived reality."

Drawing the Line: What Healthcare Professionals Are (and Aren't) Responsible For

When healthcare professionals learn to draw that line clearly -this is what I'm responsible for (expertise, information, support, documentation), and this is what patients are responsible for (choices about their own body and life) -it transforms both the therapeutic relationship and their own wellbeing.

Here's what that sounds like in practice: "I can see this is a difficult decision. I want to make sure you understand what might happen if you continue this way, but I also respect that this is your choice to make. I'm always here if you have questions or if you decide you want to try something different."

No convincing. No guilt trips. Just clarity, respect, and an open door.

We can't carry what isn't ours to carry. Getting clear on where accountability stops isn't just good for patients - it prevents burnout and restores the meaning in why we entered healthcare in the first place.

And here’s a little paradox that surprises me every time, whether for those teens or healthcare: When we give people a choice and a way out, they’re way more inclined to say “yes” and lean in.   The “for now” works here, too.   “You can try this, for now and we can re-evaluate it.”

Why This Matters for Healthcare Organizations

This isn't just about individual patient interactions—it's about organizational culture and healthcare professional wellbeing. When nurses, physicians, and allied health professionals carry the weight of patient choices as personal failures, burnout follows. When healthcare teams don't have the conflict management skills to navigate these boundary conversations, moral distress increases and job satisfaction plummets.

At Best Conflict Solutions, I work with healthcare organizations throughout Missouri and Tennessee and nationally to help clinical teams develop these crucial skills. We focus on practical strategies for:

• Recognizing when helping has become a power struggle

• Asking questions that uncover underlying needs and fears

• Finding creative third options between compliance and non-compliance

• Setting clear boundaries around professional responsibility

• Documenting patient choices while maintaining therapeutic relationships

• Preventing burnout by releasing what we cannot control

  
  

The Universal Principle: Choice and Autonomy in All Relationships

While this article focuses on healthcare, this principle applies everywhere humans interact. In management and leadership, employees who feel micromanaged become resistant. In education, students who feel controlled disengage. In families, children (and spouses) who feel pushed become defensive. In every context, when we try to control another person's choices, we create the very resistance we're trying to overcome.

The conflict management solution is always the same: clarify responsibilities, communicate consequences clearly, respect autonomy, explore creative alternatives, and stay present without attachment to the outcome you prefer.

Moving Forward: From Power Struggle to Partnership

If you're a healthcare professional exhausted by "non-compliant" patients, consider this: the problem might not be the patient's refusal. It might be that we're approaching the conversation as a binary choice when what's needed is creative problem-solving. It might be that we're taking "no" as permanent when it's really "not yet." It might be that we haven't yet learned where our professional responsibility ends and patient autonomy begins.

That line isn't always clear and learning to navigate it requires specific conflict management skills. At Best Conflict Solutions, we provide training, coaching, and facilitation services specifically designed for healthcare settings where these tensions run highest.

When healthcare professionals gain clarity about accountability versus autonomy, when they learn to have difficult conversations without creating power struggles, when they discover how to find third options between all-or-nothing choices, and when they understand the underlying needs driving resistance, everyone benefits. Patients feel respected and heard. Professionals experience less moral distress and burnout. And the therapeutic relationship becomes what it should be: a partnership rather than a battlefield.

For more conversation tips that you can use on your own or with your teams, check out Best Conflict Conversation Cards: Workplace Edition. https://www.bestconflictsolutions.com/conversation-cards

About the Author

Kimberly Best, RN, MA, is a state Court-listed mediator in Missouri and Tennessee, FINRA Arbitrator, and founder of Best Conflict Solutions, LLC. With backgrounds in both critical care nursing and dispute resolution, Kim helps healthcare organizations and professionals navigate challenging conversations and develop the conflict management skills that prevent burnout while honoring patient autonomy. I'm also not a terribly compliant patient, (my doctor would agree) yet I am willing to negotiate.

Learn more at www.bestconflictsolutions.com.