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Posted: 5/4/2008 10:19:04 PM | So, I'm a nursing student and part of my school is the clinical practice spent working in the hospital. A good number of my patients have been people with complications due to non-compliance with their medical treatment. That is, they are in the hospital for diabetic ulcers because they aren't controlling their blood sugar; or they've had a stroke because they've stopped taking their high blood pressure medication. These are just examples, and there are many, many different reasons why people have to be in the hospital. But it things that that stick with me and make me think, "Why are they non-compliant?"
So, I have a question for all of you: Do you follow doctor's orders? That is, do you take your meds as you're supposed to, cut out the stuff from your diet that you're supposed to, etc, etc, etc?
If you do, what is it that motivates you?
If not, why? Are there too many restrictions? Do you feel better? What? Tell me :) | |
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Posted: 5/4/2008 10:41:46 PM | "Why are they non-compliant?"
A huge and growing US public health problem is that patients don't take, or don't fulfill their prescriptions, with their out-of-pocket expenses. High c0-pay and/or they fell in the Medicare donut hole (it $200/month in drugs to get into it) and can't pay $5000 to get out, or they don't have insurance at all.
They look at their monthly drug expenses and realize its swallows all of their discretionary budget, and more. Retired people on fixed incomes are esp vulnerable/guilty.
Most doctors don't even bother to mention diet and nutrition. They won't even say euphemistically to an overweight person, "Your weight is a little too high" for fear of offending and losing a $patient. or the $patient says "yeah, I know" and that's finished. | |
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Posted: 5/4/2008 11:31:51 PM | In my experience, with the folks I've met on the med/surge unit, money has not been the issue. The patient I had last week suffering from diabetic ulcers that had been superinfected with MRSA was non-compliant because of drug addiction. Last semester, a patient had kidney failure because they stopped taking their high-blood pressure medication because they felt better and figured they were cured.
And my question isn't why are "they" non-compliant, I want to know why are YOU are compliant or non-compliant. I want to know what motivates individuals to take their meds and follow the regiment prescribed for them. I want to know factors, other than money (because, I assure you, that is a problem that can be gotten around with a little bit of help and some paperwork most times), are affecting one's decision to not take their meds and/or follow their regimen. I want to know INDIVIDUAL experiences, because I want to be a better nurse. | |
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Posted: 5/4/2008 11:55:28 PM | I have high blood pressure, and yep you guessed it, I have had issues with non compliance... WHY, my meds are freaking expensive... My co pays for that med is so much that at this point in the game (I'm a student to on a very fixed income) with the cost of gas, and groceries... I have to sometimes make a choice, meds or gas, meds or groceries...
As well, there are times when these meds get my BP so far down, 96/64 that I can't function... I've had high BP since the age of 27, so my body is accustome to having at least 120/80 to function...
I'm a former medical professional (X ray tech, and yes we do more than push buttons, LOL), it takes listening to a patient, and having understanding instead of harsh judgment... YES, some people do better with a stern talking to...
When I found out that my BP had risen again to a dangerous level I got myself into the Dr's and back on the meds.... However I am not taking it at the dosages she's suggested... Heck I couldn't afford the one prescription, I sure can afford 2...
It is tough to feel like you are dependant on a med for health, that sometimes played into why some of the patients I dealt with as to why they were noncompliant...
Some people, like my dad who has Diabetes II, has had a stroke, and all sorts of health issues... He's a stubborn ol goat... He refuses to change his diet so he can lose weight.
My mom contributes because she doesn't like dealing with his angry outburst so she continues to fix things he shouldn't eat...
Sometimes people have to just be allowed to be who they are... Yes, it will untimately kill them, but at the same time this noncompliance is job security, as sad as that is to admit...
GOod luck in your field...It is a tough tough job, but I have to say if you LOVE working with people in their most fragile moments of life, it is worth every minute of it... | |
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Posted: 5/5/2008 12:01:20 AM | Thank you for insight!
Anybody else? | |
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Posted: 5/5/2008 12:44:08 AM | I don't think enough patient know how to talk to their doctors and ask questions, and keep asking until they understand. Too many patient, from what I've seen in doctor offices, will come out to ask the medical office assistant the question, they should have ask the doctor. I think many people fear their doctors, it could be afraid to ask, not having a doctor that has poor bed side manner to not wanting to understand in what they have.
I know if I need prescription, I'm sensitive to alot of things out there, and will discuss it with my dr. If you can't communicate with your dr, then you're not going to have a very good relationship and what you have will not improve. | |
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Posted: 5/5/2008 6:43:38 AM | I'd like to know why people do this too.
Two examples:
I don't like to be sick, and I HATE medication (including pain meds), so I try to prevent both as much as possible. However, in the event I do become sick, I want to just treat and get it over with. Hopefully I don't end up in a position where I have to use medication permanently, and if I eat right, exercise and all I should be able to prevent most. But I'd rather know ASAP what's wrong with me and treat it fast so I can get back to living, so that's what motivates me. If I think something's off I go to a doctor immediately to make sure it's nothing major.
My mom, on the other hand thinks she knows more than her doctors do, always has. She had breast cancer and waited almost two years to have abnormalities in her breast checked that she knew were there (I had a hard time with this once she came clean - why would someone do this? Fear? Stupidity? Denial?). After she was treated and they did a swift mastectomy and removed 23 lymph nodes because it was so far gone, and 22 nodes came back positive so they prescribed chemo. She was told to inform them before going in if she felt like she had a cold, or anything like that, because chemo is dangerous to patients who are already sick. She had a bad cold, but lied and started chemo anyway...and actually said "eh, it won't do anything to me." They told her after her mastectomy and before the drain came out not to do anything strenuous. She said ok, then drove, mowed the lawn and put in a window AC - same thing "eh, it won't hurt anything" before ending up taking three more weeks to heal and getting a bad infection where the drain was. I don't know, stubbornness, denial and a death wish I guess. I found out the doctor told her she had several types of cancer from the tests they did, but she never told us so that we wouldn't question her. Self sabotage? I don't know but it's frustrating dealing with someone who does this.
I hated her for a while during this time - it was like she didn't care if she died, she just did a lot of dumb stuff...I can't explain it but it pissed me off. Also it seems like a lot to put yourself thru when you could have caught it earlier and been sick less, spent less money, worried less, etc. | |
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Posted: 5/5/2008 7:32:06 AM | Sugargirl760; Congrats on your career choice, if you're compliant with what your instructors teach you then you won't be disappointed.
I suppose reasons for non compliance fall into clusters and are as varied as there are people and there's probably a connection between specific issues of non compliance and types of illness. Coming to terms with a newly diagnosed disorder is no easy task for anyone and making lifestyle adjustments requires a lot of effort. I think people go through a process similar to the stages of loss, many get stuck along the way in one stage or another. Your task will be to help them along the way toward acceptance, that's the bottom line.
Money, education, convenience, accessibility, communication, priorities, ability or resistance to change,understanding, intelligence, sense of well being, adverse reactions, expectations of results, support systems and practical considerations are all factors that relate to non compliance.
Your task will be to make an assessment of your patient and intervene in a manner that facilitates the best possible outcome for the patient's managment of whatever illness they've got. The greater your experience, knowledge of medications, understanding of illness and ability to communicate the better you'll be able to address the issue of non compliance. | |
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Posted: 5/5/2008 7:52:40 AM | | i hear ya sugargirl. I work on a med/surg unit and I see some horrible things due to non-compliance as well. A 23 yr. old kid on dialysis because of failure to comply with a diabetic diet/fluid restriction. As for me, there was a time I didn't have health insurance and had to pay for prescriptions out of pocket which cost $600/mo. It was either pay rent, or take my meds. I chose to pay rent. The consequences were devastating, but I think some people are luckier than others. The people who are fortunate to get health insurance, govt. assistance. I get angry at non-compliant patients, but I tried to put myself in thier shoes. I tried to imagine having diabetes, and not being able to eat certain foods. It's not that easy. Sometimes, I forget to take my meds in the morning. It's not always that easy to be compliant. It's something you really have to work on. Especially with mental health patients....of course they go off their meds...they are way too expensive, the docs are changing them up all the time, I can sympathize with some non-compliant patients, but it's very hard to. It's when the patients get really mean and refuse all treatment and get verbally abusive towards the staff...that's when I can't tolerate it. I've encountered a lot of dialysis patients who are verbally abusive and non-compliant. It is hard to be compassionate when people are cruel, but I can understand to a point why they are this way. | |
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Posted: 5/5/2008 8:17:22 AM | | ellesbelles26; You've got to understand that when patients express their anger at staff it's because they're looking at thier own unsuccessful attempts at problem solving. They screwed up, not you. Your compassion is evident in the fact that you do your job the best you can. You didn't push them off their bike, they fell off all by themselves, they're pissed cause they bruised thier knee, you're just cleaning it and putting on a band aid. | |
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Posted: 5/5/2008 2:52:48 PM | think about it for just a second...aren't most people there in the first place because of lifestyle choices such as over-everythinging. They have behavioral patterns that they have been pursuing over much of their lives which has resulted in them having to seek medical attention....it is asking a lot for a person with 20 years of bad habits to all of the sudden start paying attention to their bodies....
....the perfect example.....the person that smokes through their stoma..... | |
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| Compliance
Posted: 5/5/2008 4:56:34 PM | It's quite frustrating to take care of a patient that is only there because they just can't do what they know they're supposed to. I'm only a phlebotomist but I know the feeling because few people hold the cotton down as long as I want them to and they walk out refusing a band aid and come back in a few minutes later with blood pouring down their arm.
I think a lot of these people are forgetful and don't understand their medications well enough, or how medication works in general in order to take it properly. A lot of people think when they 'feel better' they can stop taking something, but in truth sometimes you HAVE to take that med forever to keep the condition from coming back.
I do what I'm told by my doctor and best as I can. If I don't and something gets worse, I have no right to complain to him. | |
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Posted: 5/7/2008 6:24:56 AM | Yep - most patients are your patients because of chronic medical conditions that are self-inflicted. Ex: Type II diabetes, smoking and obesity related disorders>
NOT TALKING ABOUT FOLKS WHO REALLY CAN'T HELP BEING ILL, HERE, BUT
Many of them came to the doctor in the first place hoping for a "magic bullet" that would enable them to continue their unhealthy ways with no consequences.
I take the best care of myself as I can, have NO chronic illness, and usually need to see the doc less than once a year for something besides annual physical. But -- just like millions of the rest of us -- my insurance premiums went up 43% this year (to cover the cost of these folks.)
And my heart really goes out to those of us with low quality or NO insurance costs -- they are REALLY footing the bill for others! | |
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Posted: 5/7/2008 9:42:50 AM |
I don't like to be sick, and I HATE medication (including pain meds), so I try to prevent both as much as possible. However, in the event I do become sick, I want to just treat and get it over with.
I feel the same way. Taking pills or medication has really never been part of my daily routine, so when I get sick I forget to take it. If it's a one a day pill, I remember it most of the time, and take it first thing. But pills that are through out the day, they slip my mind.
Even with vitamins or supplements, I'm the same way.
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Posted: 5/7/2008 9:57:44 AM | I do follow my doctor's orders, well... to some degree. Right now I do for sure but before I used to feel like a number, I would walk in, tell him my problem and he would write a prescription. This really bugged me but I heard from friends and family that this was more or less the relationship with everyone's doctor. Well at one point last year or the year before, I got fed up with feeling like a number and being treated with drugs. So the next appointment I pretty much told him how I felt and he had a big smile on his face when I told him that I do not want to treat the symptom but treat the problem. Now we have a great doctor/patient relationship. If I have a small cold, he wont prescribe antibiotics right away unless its really bad. So at the moment I do follow my doctor's orders and I do take the med's he prescribes when the time comes, but I always do my research beforehand and talk to him openly about any concerns I have with the drug.
What motivates me is to be healthy :)
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Posted: 5/7/2008 11:52:57 AM | | Fabulous. Thank you! Textbooks offer toms of information from which I can speculate, but hearing from individual first-hand what they do and have done helps and makes for a crystal clear picture! | |
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Posted: 5/7/2008 12:55:33 PM | Sugargirl the hardest rotation you will learn to really love is working with peds... They are the ones that generally aren't there because of something they aren't doing right... The power and strength these little ones have, that have been chronically ill their entire childhood will bring you to tears...
It can be easy to forget that people are just people, and it is true some people hold an unhealthy life style, and hope that their is a magic pill that will help them continue their poor life style... | |
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Posted: 5/9/2008 4:47:26 AM | | One thing I've experienced personally is that all my medical problems went away when I started getting serious about diet and exercise several years ago. There wasn't any magic pill, just had to decide to commit to having a healthy lifestyle. But it's a change in lifestyle that people tell me is extraordinary, even if I think it's not that special. | |
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