Moving Us Closer To Osler
A Miller Coulson Academy of Clinical Excellence Initiative

Practicing Non-Judgement


A key to persuading patients to make healthy choices is a strong therapeutic relationship.

Reflecting on authoring, “Do Words Matter? Stigmatizing Language and the Transmission of Bias in the Medical Record,” I’m again struck by the importance of practicing non-judgement; we really have no right to judge.


The vignette in this paper is roughly based on a patient of mine—tough and rough around the edges, but an incredible person once you get to know him, who absolutely loves watching Disney movies with his granddaughters.


I’ve learned so much from him and it breaks my heart that based on subtle changes in the words in his medical record, his care could be suboptimal, which could lead him to suffer longer in pain.


He was distrustful of me when we first met, due to prior experiences with his healthcare team, and he has had some dreadful complications of his disease. He was initially adamantly opposed to my recommendations and did his own thing and he actually did well for a while. We continued to have clinic visits, I would continue to recommend he start hydroxyurea, he would continue to refuse, but I respected his choice and he became more trusting. He had another complication and after many years he finally agreed to start taking hydroxyurea and has been really adherent (never misses a dose) and is doing well.


Sometimes patients choose not to take our advice, and we may wonder why they are coming to see us at all. This is a reminder that a clinic visit isn’t just about the prescription, it’s about building a therapeutic and trusting relationship. When that happens, some patients (not all) will be more adherent.


My hope is that in real life someone will read his medical record and then go and talk to him and try to connect, in order to really understand and provide appropriate care.