Denial is more than a river in Egypt...

[cookienay]

OK- so we all have patients who completely deny that they have any medical conditions or problems, yet appear chronically ill or are taking a boatload of meds. But last week I had a guy who took the cake. As I was taking his PMH he advised me that he has had almost 20 stents. A few questions later, he revealed that he smoked 3 packs a day. To which I say "No wonder you have had 20 stents." With a complete straight face he says..."Oh, mine is hereditary. My smoking has nothing to do with it." Huh?

And then the lady who adamantly denied she had diabetes. She was taking metformin so I asked her why she was taking metformin (thinking she could be taking it for PCOS). So she tells me "My pancreas does not produce insulin, so I have to take this medication so my pancreas makes insulin." When I informed her that is almost a textbook definition of diabetes, she still insisted that her doctor said she did NOT have diabetes. I really did try to educate this lady in my brief time with her, but who knows how effective it was. And the bad thing is-I believe her when she says her physician told her she did not have diabetes.

You win some and you lose some. :)

[glassdollvn]

As well as acceptance....:)

[JulieCVICURN, BSN, RN]

Well, according to your patient's description it does sound like she has diabetes (and maybe a not so smart doctor) but I can tell you from personal experience that there are lots of people who are impaired glucose tolerance (but don't quite meet criteria for true type 2 diabetes YET) who are on metformin as a preventative. My endocrinologist told me that there's evidence that using metformin in impaired tolerance has been shown to delay the onset of diabetes.

[roser13, ASN, RN]

I do a PMH telephone assessment on roughly 30 patients daily. I must say that there seems to be an epidemic of diabetic and pre-diabetic patients whose PCP's are clearly disguising the diagnosis of diabetes in confusing language.

These patients are taking one or more oral agents, yet insist that they're not diabetic. Some are taking insulin daily, yet insist that they are not insulin-dependent.

"Insulin-resistant"

"pancreatic disorder"

"My body doesn't recognize insulin"

I get the distinct impression that these descriptions are coming from the primary care doc - I just can't figure out why an MD would try to sugar-coat (:uhoh3:no pun intended) the diagnosis.

[cookienay]

Roser- I completely agree! It appears to be the case here, IMO. Even my own sister experienced this.

JulieC- That is so funny that you say that about what your endocrinologist said. At our recent Diabetes Update, our endo. told us almost the exact opposite. That the current wisdom is that there really is no such thing as "pre-diabetes". You have it or you don't. I wonder if these differences are regional or just different interpretations of all the data? Hmmmmm....

There is also a strong cultural factor in my area why patients deny their illnesses. And almost every ER nurse knows of at least one instance when a woman who was actively in labor even denied it was possible to be pregnant. But that is a thread for another day.

[NRSKarenRN, BSN, RN]

Add my Dad to your list of those who does not have Heart Disease but had an MI 25 yrs ago, CABG x 4 '05 and high cholesterol. "My hear muscle is ok, just the plumbing part that needed to be replaced --guranteed for about 20 years"

[d'cm]

Hey, she knows whats wrong and takes her meds, that's more than most of my patients. Who care what she calls it.

[kellyc034]

My Mom died from COPD, but I still remember her arguing with me in the MD exam room saying it was "not proven" that her 40 years of smoking caused the emphysema. LOL. The pulmonologist actually rolled his eyes at her, and said "Lemme tell ya, it's proven!"

Kelly

[roser13, ASN, RN]

.....the patients who take Diovan, Norvasc and HCTZ yet deny that they're hypertensive.

"My blood pressure's fine every time I go to the doctor!"

[JulieCVICURN, BSN, RN]

JulieC- That is so funny that you say that about what your endocrinologist said. At our recent Diabetes Update, our endo. told us almost the exact opposite. That the current wisdom is that there really is no such thing as "pre-diabetes". You have it or you don't. I wonder if these differences are regional or just different interpretations of all the data? Hmmmmm....

Yeah, I don't know. All I can tell you is that for 3 years I was considered to have impaired tolerance and was on metformin, and now I'm considered to be diabetic (so, really, there's been no "sugar coating") and my dose has doubled. The diagnosis changed about 3 months ago, and I'm seeing the exact same doctor. I got regular HgA1C's and fasting glucose levels and was being followed very closely. Nobody on this end is in denial about it, but I can't speak for other physicians.

[caroladybelle, BSN, RN]

Dad died of emphysema.

To his dying day, he swore it was from his work in the military and had nothing to do with the 4 pack a day Pall Mall habit x 40 years.

His family, of course, smoked all through the funeral. Aunt Dot took a brief break from smoking to throw herself (no, I AM NOT KIDDING) in the coffin, screaming, "My Baby Brother, he died so young... and blamed the StepWitch....oops, stepmother for not feeding him right.

They, like so many of my patients, also claim to have "a touch" of emphysema.......

[cookienay]

JulieC- sorry did not mean to imply that you or your MD were mistaken or in denial. I see now that my post can be read that way. Simply commenting on the varying info that patients and nurses receive. Things just don't come across in text as they do in person!

Oh, and then there is the lady who tells me she has no history of mental illness, but can tell me she is allergic to Cogentin and Haldol. I forgot about that one!