I usually don't take offence at what a patient might say.

Today was an exception.

I saw a 62 year old woman for the first time- she had seen my colleagues in the previous months for her diabetes. She came in with no glucose logs (she hadn't been testing). She had not been taking her diabetes meds. Indeed, her blood pressure was 160/90 mm Hg; she had also deferred her ACE-inhibitor, and had refused treatment with a statin for her LDL of 168 mg/dL as well.

Not surprisingly, her hemoglobin A1c was 9.8%. And so, I urged her to consider changing her ways, and to take her prescribed medications.

To which she said, "I wonder how much commission you make prescribing these medications?".

I was rudely surprised at that question.

I firmly answered: "Nothing. We make zero dollars prescribing a medication".

Unlike some parts of the world, here we doctors prescribed and the meds are picked up only at the pharmacy (plus the medications she was supposed to be on are generic, anyway).

So I gently but firmly told her that if she wasn't willing to take our advice, and thinks we have ulterior (financial) motives, why was she choosing to come for her 3 monthly visits anyway? What good were these visits, if she didn't heed our advice?