Published 23 April 2025

A middle-aged woman comes in for a follow-up. She has poorly controlled diabetes and is on high doses of insulin. She has also been prescribed a low dose of a antihypertensive, but now insists on having the higher dose she was previously on.

She’s convinced that since the dose was reduced, she’s been experiencing palpitations. She’s firm — almost forceful — in her request to go back to the higher dose. The problem? That higher dose goes against clinical guidelines for treating hypertension in diabetic patients.

I was faced with a choice.

I could have taken the time to explain the physiological implications — the risks to her diabetic control, the rationale behind the guidelines. I could have offered to switch her to a different medication that might work better overall. Or, I could take the path of least resistance and simply concede.

On that day, I didn’t have the energy or time to open the conversation up. The patient was assertive, I was tired, and I let it go. I prescribed what she asked for.

In the aftermath, I found myself turning to the framework of the Four Truths — objective, subjective, normative, and complex truth — as a way to make sense of the encounter.

• The objective truth: Medically, the higher dose might worsen her diabetic control.

• The patient’s subjective truth: She feels better on that higher dose and experiences distress without it.

• My own subjective truth: I experienced her as a difficult patient. I felt cornered, and perhaps even a bit resigned.

• The normative truth: Traditional medical culture holds that patients should follow a doctor’s advice. But an alternative, emerging norm is that patients should be active participants in shared decision-making.

Then there's the complex truth — the recognition that all of these truths can exist simultaneously, and that no single perspective holds the full picture.

This framework has helped me reflect not just on what happened in the consultation, but also on what was happening in me. The interplay of fatigue, frustration, and power dynamics; the tension between patient autonomy and clinical responsibility; the desire to "get it right" despite the limitations of time and capacity.

These are precisely the kinds of tensions that coaching has helped me navigate with more clarity and compassion. Coaching doesn’t offer quick fixes — just like medicine often doesn’t. But it does offer space. Space to explore, to hold complexity, and to act from a more integrated and conscious place.

Next time I see this patient, I hope to bring that kind of presence to the encounter. And perhaps that’s one of the quiet gifts of coaching — not just for the people we support, but for ourselves.