Vexing challenges arise in clinical care when patient preferences are at odds with the standard of care. In the hospital setting, such patients on a medicine or surgical service may come to the attention of the psychiatric consultant when “denial” is viewed as an obstacle to appropriate care. In the outpatient setting, these patients are more likely to miss appointments, have persistently poor outcomes, and risk polypharmacy and serial hospitalizations.1 Patients with chronic disease and comorbid mental illness are an especially complicated population in this regard, increasingly recognized as commanding a disproportionate share of health care spending while experiencing inferior outcomes.2 These trends are even starker for patients dually diagnosed with substance use disorders.3 While such patients may represent but a fraction of the nation’s overall population, their effect on the clinical delivery system is profound.
Williams AR, Olfson M, Galanter M. Assessing and Improving Clinical Insight Among Patients “in Denial”. JAMA Psychiatry. 2015;72(4):303-304. doi:10.1001/jamapsychiatry.2014.2684