The Present-Oriented Patient
Dealing with present-oriented patients can be challenging and frustrating for a myriad of reasons. They often do not consider the future implications of present-day plans and struggle to see the point of preventive care, opting instead to seek treatment for health problems as the symptoms arise. Interacting with present-oriented patients requires some cultural competence on the part of the members of the healthcare team.
Even though the telephone conversation took place more than four years ago, I remember the details with striking clarity.
My best friend, who was working as a nurse at a county-owned clinic in a low income area at the time, called me to talk about a patient she had seen that day. The patient, a pleasant African-American female in her late forties, visited the clinic for treatment of poorly controlled hypertension and type 2 diabetes.
"I wake up some days and I just don't feel like taking my medicine," the patient chimed with a very matter-of-fact tone of voice. "I just don't want to take it."
The youngish internal medicine physician responded, "Your fasting blood sugar is 260 and your blood pressure is really high. High blood pressure and diabetes are two diseases that will kill your kidneys if left uncontrolled. You'll end up on dialysis in the distant future if you don't take your insulin and antihypertensive medications." He paused for a few seconds before continuing. "Is there a specific reason you don't want to take your medications? Are they too expensive? Do they make you feel physically sick?"
"Most of my medicines are on the $4 Wal-Mart list," the patient said. "And they don't make me feel sick or anything like that. I just don't want to take them. I don't feel like taking them."
The young doctor offered another blunt response. "Diabetes makes your blood vessels inelastic if uncontrolled. If your blood pressure gets too high, you might have a major stroke. Many people who have had major strokes are wearing diapers, have feeding tubes, and will never walk again."
The patient smiled and shrugged, seemingly unconcerned. "I just don't like taking my medicine."
Although my friend and I privately express our frustrations about patients who do not want to comply with the plan of care, we are not surprised. After all, both of our families are full of relatives who are present-oriented. My friend's mother is a present-oriented lady who lives from moment to moment. My father is present-oriented, lives for the day, and does not think much about the future. Predictably, her mother and my father have both reached upper middle age without saving a dime of retirement money or planning for the future, but they seem perfectly happy living in the 'here and now.'
And yes, the patient she saw in the clinic that day most likely had a present time orientation. According to Jenko and Moffit (2006), present-oriented individuals have difficulty incorporating the future in present-day plans. Patients with a present time orientation tend to live for the day since they believe that tomorrow is not guaranteed. Due to their minimal or nonexistent focus on the future, present-oriented people are prone to seek instant gratification and immediate pleasure without any thought on how their behaviors today will impact them in the future. These patients might not respond favorably to preventive care that focuses on preventing future health problems.
On the other hand, future-oriented people are more apt to delay gratification and engage in present inconveniences to ensure comfortable futures. These patients examine all current pursuits for any future advantages. For instance, the patient who jogs several miles every morning is participating in a time-consuming activity that some would deem grueling, but the future benefits include enhanced cardiovascular health and excellent weight control. Patients with future time orientations generally keep medical appointments, comply with the plan of care, and set up advance directives and living wills to prepare for future events.
Are there any tips on effectively dealing with present-oriented patients? Yes! Since they generally enjoy social interaction, healthcare facilities can set up inpatient or outpatient group activities such as diabetic education classes that offer prospects to socialize and learn about disease processes at the same time. Present-oriented patients also prefer instant relief when they feel bad, so this is the golden educative opportunity regarding their medications. You can inform them that their headaches might instantly ease up if they take their blood pressure medicine on time, or their edematous legs will quickly improve if they take their diuretic pills as prescribed.
Dealing with present-oriented patients requires a degree of cultural competence on the part of the members of the healthcare team, but we can effectively reach them with some creativity, plenty of patience, and the right approach.Last edit by Joe V on Feb 1, '13
About TheCommuter, BSN, RN Moderator
TheCommuter is a moderator of allnurses.com and has varied workplace experiences upon which to draw for her articles. She was an LPN/LVN for four years prior to becoming a registered nurse.
TheCommuter has '11' year(s) of experience and specializes in 'Case mgmt., rehab, (CRRN), LTC & psych'. From 'Fort Worth, Texas, USA'; 36 Years Old; Joined Feb '05; Posts: 38,035; Likes: 69,187.Feb 1, '13As per usual, another interesting & thought provokinng article. Makes one wonder into which group he/she falls.
Commuter, I continue to enjoy reading your articles.Feb 1, '13I'm a mere student lpn, but I really learned a lot from your article...I've heard of the 'present- oriented patient', but didn't fully comprehend it until I read your post...I will recognize this phenomenon now that you have explained it so well...thanks Commuter...I always take heed to what you have to say because you really make me think...keep the wisdom coming!Feb 1, '13I think sometimes the present is all that people can handle. There have certainly been times in my life when I only considered the present because I didn't have the energy to worry about the future.Feb 1, '13Quote from kabfighterStress, poverty, and other social issues tend to result in a present-oriented outlook. After all, a homeless person is not going to do much future planning if he has more immediate needs to fulfill right now for his survival (finding shelter, food, water, safety from harm, etc.). A female who is being physically abused by her spouse on a regular basis is not focused on future events; rather, she's concentrating on the 'here and now' (survival, safety, possibly extricating herself and the kid(s) from the situation).I think sometimes the present is all that people can handle. There have certainly been times in my life when I only considered the present because I didn't have the energy to worry about the future.
However, without ever having met you, I can tell that you have at least some degree of future orientation. You're a young nurse. You've attained a college education. Many hardcore present-oriented people cannot delay gratification and do not see the future benefits of higher education until it is too late, so they are prone to drop out of high school or college to undertake something else that seems more urgent at the moment. Finishing college during one's youth indicates a future time orientation, some impulse control, and the ability to delay gratification.Feb 2, '13This really makes me reevaluate some of the patients I had last semester with uncontrolled HTN and worsening CHF.Feb 3, '13Thank you for this very well explained and informative article! Would really help me in my practice=)