Autonomy and Medicine Don’t Need to Be Mutually Exclusive

Martha Richards
Sep 3
10 min read

Updated: Sep 5

Asking for patients to be treated with dignity and autonomy is not extreme, or some sort of crusade — it’s basic human decency.

Yet our medical system wasn’t designed around listening. It was built to manage disease, to intervene in crisis, to maximize profit — and along the way, it has rewarded sickness instead of health. More medications, more procedures, more visits — but fewer moments of real listening. Over time, patients stop questioning (sometimes even fear questioning), doctors stop explaining, and autonomy slips away.

The results can be heartbreaking — and sometimes dangerous.

When Patients Aren’t Heard

My father, age 82, made it clear during his recent hospital stay that he only wanted to take medications related to his heart stents. He came home with an extra prescription he didn’t agree to, and it dropped his blood pressure so low he was dizzy for hours. At his age, on anti-platelet medications, a fall involving the head could have been catastrophic.

My experience with a hand surgeon in Ann Arbor: I went in, barely functioning from pain, and asked for a steroid shot. His response? “I’m sorry, you’re not getting what you want.” He insisted on surgery, brushing off the fact that I’d be out of work for six weeks. I walked out in tears — not just from the pain in my hand, but from feeling unheard, unseen, and uncared for.

My thyroid story (as a med student): I knew I did best on a T3/T4 combination, and before my Step 2 exam — nine hours long with only 45 minutes of total break time — I begged my endocrinologist to adjust my dose so I wouldn’t crash. When I told her I disagreed with the dose she prescribed (and even showed proof I’d been on the requested dose before with another practitioner), she looked at me and said: “I’m the doctor and I decide.” What happened? Exactly what I warned her about: crushing fatigue, heavy menstrual bleeding, and having to do jumping jacks and squats outside the testing center just to stay awake. When I followed up afterward, instead of adjusting my medication, the office told me they were firing me as a patient.

My best friend’s grandfather, age 96, told his doctor: “I’ve had a good life.” The doctor interpreted that as depression and prescribed an antidepressant. He became sedated and less himself, until my best friend intervened: “He’s not depressed. He’s a 96-year-old man who knows he’s dying.” Thankfully the medication was stopped, and he was able to die peacefully.

My best friend’s postpartum ER visit: After giving birth, she needed Benadryl. Sensitive to medications, she asked for half the dose. The nurse refused: “This is what the doctor ordered.” When she pushed back again, the nurse replied: “We give this dose to twelve year olds.” My friend was given the full dose anyway — and her blood pressure and heart rate spiked. She started slurring her speech and, in the moment, feared she might be having a stroke. The nurse, panicked, ended up sitting with her the entire time because she knew she had made a mistake. The harm could have been avoided if only someone had listened.

During Family Practice residency, I was required to use opioid agreements with my patients. These contracts allowed me to drug test them at any time, and if they had other substances in their system — even marijuana — I could cut them off from their prescription. I hated those agreements. Either I should prescribe a medication or I shouldn’t, but what someone does with their body outside of that should be their choice. What would have actually made sense is educating patients about what substances are unsafe to combine with opioids — but who has time for that in a system that rushes you through every visit? Instead, the agreements became just another way the system stripped patients of autonomy.

I don’t believe any of these clinicians woke up intending to harm. Most went into medicine because they wanted to help. But inside a system that values money, control, efficiency, and liability over humanity, listening often gets lost. And the patient pays the price.

When Patients Are Heard

Thankfully, not every story is bleak. There are moments of light that show what’s possible.

When my dad had his first heart attack and triple bypass surgery, he came back from the operating room still intubated. The respiratory therapist explained they would extubate once his numbers — blood pressure, heart rate, oxygen saturation — came back into range. But they weren’t improving. I looked at him and knew something was wrong. I told the PA, “You need to look into this.” They listened.

Within minutes, an x-ray tech was in the room where they discovered fluid in his chest — a blood vessel had been missed during surgery. He was rushed back into the operating room, the leak was fixed, and he returned to recovery. Later, when the team wanted to wait for his numbers to be even better before extubation, I pushed back again. The low numbers before weren’t because of his body — they were because his chest had been filling with fluid. Intubation itself carries risks, and I said no. They listened to me again.

I’ve experienced this myself, too. In 2019, an MRI of my brain found a lesion we were not looking for. In Oregon, one doctor recommended “watch and wait,” scanning every six months. Later in Michigan, another doctor pushed for a biopsy, calling it “no big deal” — but drilling into my skull felt like a very big deal to me. We compromised: scans at three, six, nine, and twelve months. When nothing changed, he suggested annual scans. I decided that was enough. They reached out a year later to schedule another, and I said no. Thankfully, I haven’t heard from them since.

That experience reminded me: my health is my responsibility. Doctors can offer opinions, but only I can decide what benefits and risks I’m willing to take. And that truth applies not just to physical health, but to emotions and feelings, too. Many of the hardest things that happen to us aren’t our fault — but healing them is still our responsibility. No one else can do that work for us.

Where Medicine Shines

I want to be clear: our medical system does a relatively good job with acute care. If you break a bone, need stitches, or are in a serious accident — you want our emergency teams on your side. Surgeons, trauma doctors, ER nurses, anesthesiologists — they save lives every single day, often in extraordinary circumstances.

That’s what the system was built for. High-tech interventions, rapid response, fixing what’s immediately broken. And for that, I’m grateful. My dad’s stents and bypass surgery were possible because of acute care medicine.

But when it comes to long-term health, chronic conditions, and true healing, the system struggles. It doesn’t always listen. It doesn’t always respect autonomy. And it often prioritizes profit over prevention.

That’s where the cracks show — and that’s where patients need to step up, ask questions, and reclaim their voice.

The Bigger Picture

The consequences of not listening are devastating. A study in the Journal of Patient Safety estimated that 200,000 to 400,000 Americans die each year from iatrogenic causes — harm caused by medical care itself. That makes medical harm the third leading cause of death in the U.S.

Medicines are, by design, powerful substances. They can save lives, and are best used when the benefits outweigh the risks. But patients deserve the full picture so they can make the best choice for themselves.

This isn’t about rejecting medicine. It’s about reclaiming what should never have been lost: the right to be heard, to be respected, to be an active participant in our own care.

Outsourcing vs. Responsibility

This isn’t just about medicine — it’s about how we live. We’ve been conditioned to outsource responsibility, to point the finger outward: that person annoyed me, that person made me angry, that person did me wrong. But the truth is, we’re not upset because of them. We’re upset because of our own conditioning.

Until we deal with that conditioning, we’ll keep outsourcing responsibility for our health, our emotions, and our lives. And outsourcing might feel easier in the moment — but it never leads to real health, or real freedom.

The only person you can ever truly change is yourself.

When it comes to health, that means listening inward. Not waiting for the system to fix you, not handing over your body to someone else’s authority, but taking responsibility for your choices and your healing. Doctors, nurses, coaches, reflexologists — we can all offer suggestions. But suggestions are not the same as responsibility. That part will always rest with you.

What We Deserve

Autonomy and medicine don't need to be mutually exclusive. We can — and must — have both.

Doctors know a great deal, but they don’t know everything. We live in our bodies every single day. Both forms of knowledge matter, and real care only happens when they are brought together.

A Call to Action

If you’ve ever felt dismissed, silenced, or pressured in the medical system, you are not alone. And you are not powerless. You do have agency. You can ask questions. You can say no. You can seek out providers who treat you as a partner, not a problem or a disease.

And if you’re not sure where to start, that’s why I offer healthcare navigation coaching. Because no one should need a person with a medical degree in their close circle to feel safe in the system. Everyone deserves the tools and confidence to advocate for themselves, to protect their autonomy, and to reclaim their health.

Another option worth exploring is direct primary care (DPC). Unlike traditional practices that are forced to rush patients in and out, DPC physicians spend real time with you — and time is the most important ingredient in being heard. Insurance companies have steadily decreased visit lengths, and that helps no one.

If you’re in Michigan, two excellent DPC options are:

Beyond Primary Care (Ann Arbor)
Plum Health (Detroit and other cities)

Sidebar: Why Insurance Companies Profit More When You’re Sick

Health insurance is supposed to protect you, but the way it’s built in the U.S. actually means insurers make more money when you’re unwell. Here’s how:

You pay premiums every month (whether you use care or not).
They pay out claims (what doctors, hospitals, and pharmacies bill).
Their profit comes from the gap between what they take in vs. what they pay out.

If more people are sick:

They can raise premiums, deductibles, and copays “to cover rising costs.”
They still limit what’s covered (certain treatments, meds, or preventive care).
Chronic illness is their sweet spot: predictable, lifelong, and billable.

If everyone were healthy:

People would switch to cheaper plans or drop insurance altogether.
Insurance companies would lose revenue and power.

So instead of rewarding health, the system encourages dependency. It’s not designed around people getting well — it’s designed around people staying customers. Ick. Just ick.

What You Can Do Right Now

The medical system may be flawed, but you still have tools to protect your health and your autonomy. Here are some steps you can take today:

1. Ask questions — every time.

Know what medications you’re on and why. Ask your doctor: “What is this medication for? What are the side effects? Are there alternatives?” If your doctor is annoyed or dismissive, that’s your sign to find another provider. A physician who can’t handle questions shouldn’t be making decisions about your health.

2. Know your medications.

Don’t just take pills because they’re handed to you. Look them up, read about potential side effects, and pay attention to how your body feels. If something seems off, bring it up. There are often alternatives, but you won’t know to ask if you don’t understand what you’re taking.

3. Build healthy foundations.

Your lifestyle matters most:

Movement: Move daily in a way that feels good — walking, stretching, dancing, lifting, whatever works for you. Exercise lowers risk of chronic disease and boosts mental health.
Food: Prioritize whole foods, vegetables, and protein that sustains you. “The right diet” isn’t one-size-fits-all.
Hydration: Drink enough water. Even mild dehydration can affect energy, mood, and focus.
Fresh air and light: Time outdoors improves mood, sleep, and overall well-being.
Sleep & rest: Protect your rest. Poor sleep raises the risk of almost every chronic illness. Practice sleep hygiene: no screens an hour before bed, keep your room cool and dark, and consider 1–2 mg of melatonin if you’re over 50. Build in rest beyond sleep, too — time away from screens, gentle recovery, quiet moments.
Stress management: Meditation, journaling, therapy, or coaching all help regulate the nervous system. Even 5 minutes a day matters.
Discernment with substances: Be aware of alcohol, tobacco, or even overuse of supplements/medications. Your body deserves clarity and balance.
Preventive check-ins: Screenings or basic labs can be useful — not because doctors “say so,” but because data helps you make informed decisions for yourself.

4. Protect your joy. Health isn’t just the absence of illness — it’s the presence of vitality. Do things that make you laugh, smile, and feel playful. Joy is medicine, too. Whether it’s time with friends, art, music, nature, or playing with your dog — these moments regulate your nervous system and remind your body what it feels like to be alive and well.

5. Build supportive community. Surround yourself with people who uplift you. Limit draining or toxic interactions when you can — relationships affect health more than most of us realize.

6. Book time with a guide.

Sometimes it helps to have someone walk beside you as you navigate your health. You can make an appointment with me to go over healthcare navigation, a wellness plan, or simply to make sure you’re on the right track caring for yourself. Having an ally who knows both the medical system and holistic approaches can make the journey less overwhelming and more empowering.

A Note on Research

Exercise: Regular activity reduces risk of heart disease, diabetes, and depression (CDC, 2022).
Sleep: Poor sleep is linked to obesity, diabetes, and cardiovascular disease (NIH, 2015).
Melatonin: Natural production decreases with age; low-dose supplementation can improve sleep in older adults (Sleep Medicine Reviews, 2017).
Community: Strong social connections lower mortality and improve mental health (Am J Epidemiology, 2010).
Laughter and play: Laughter reduces stress hormones, boosts immunity, and lifts mood (Mayo Clinic, 2021; Am J Lifestyle Medicine, 2016).

Closing

I don’t write this out of anger, but out of compassion — for my family, for my friends, for my clients, for every human being who deserves to be heard.

Because here’s the truth: we are not broken. Except in the case of acute injuries — broken bones, cuts, emergencies — medicine doesn’t “fix” us. And even then, it’s the body that does the healing once the immediate damage is addressed.

For chronic issues, medicine doesn’t fix anything. It manages. It masks symptoms. It tells the body to quiet down rather than asking what it’s trying to say. That might create short-term relief, but it silences the very signals we most need to listen to.

Real healing comes from listening. From caring. From compassion. And from reclaiming the responsibility that only we can take — to honor our bodies, our choices, and our lives.