Clueless Patients and The Problems They Cause

[AngelfireRN, MSN, RN, APRN]

Just had a couple of dillies yesterday, and wondered if any of y'all run into this where you are.

1) LOL is on the table, having a heart cath. The doc tells her that we have to send her to a different hospital for further intervention, based on the results. The LOL tells the doc to print out pictures of the problem areas, go and show them to her husband, and he will decide whether or not she needs to go.

2) We call a lady to schedule an appointment after an abnormal test, and to advise her that she will likely need a cath (that was the purpose of the visit, to allow us to explain why). The first question out of her was "Well, how abnormal was it? I have plans tomorrow, and I am getting my preop done, I can't come. I really don't see why we have to jump right to another test just because one was a little funny."

"Ma'am, this test was abnormal to the point that we are pretty sure that you need a cath. We can tell that something's not right, but we can not be sure how not right it is untile we take a look at your arteries."

"Well, what is the doc's name? OK, I'll discuss this with my husband and let you know if I'll be there."

#1 did get transferred, and #2 did show up, but GOOD LORD!

Yes, I will discuss things with my DH, if it can wait to be discussed. But in the above instance, especially number one, my only comment to my hubby would be "Get my things, please, and meet us there. I love you."

This just blew my mind.

Any of you seeing anything similar?

[prowlingMA]

I have had a patient newly diagnosed with cancer leave the exam room and walk down the hall saying " I don't think I have cancer, he is lying, I am not sick. I don't need all that stuff ( chemo) that he talked about."

OMG YOU HAVE CANCER. The doctor would not lie about it.

[TheCommuter, BSN, RN]

I don't think these patients are clueless. They've certainly got a clue, but I feel they're pretending to be clueless as the result of passive aggression and quiet resistance.

Instead of pure cluelessness, I'm seeing more of a silent power struggle as evidenced by statements such as "I have plans," "He will decide," and so on.

[PAERRN20]

Oh my gosh yes! ER nurse here and I can't believe some of the things patients refuse to be transfered for. Lacerated organs, active MIs, hemorrhages, brain bleeds, trauma, the list goes on and on. I realize that health literacy is low but cmon. When the cardiologist/surgeon/neurologist/ER doc says that you need to leave now on the helicopter or you will die you listen!!! Or at least I would. Everyone else- not so much.

[Jaila]

I think all I can say on this is to quote Ron White ... "you can't fix stupid" :)

[AngelfireRN, MSN, RN, APRN]

I have said a million times that there should be a medically recognized diagnosis of Too Stupid To Live.

[Purple_Scrubs, BSN, RN]

Well, is it stupidity, or is it a cultural difference (husband makes decisions for the family)? Is it stupidity, or the normal grief reaction of denial to a frightening diagnosis? I understand it can be frustrating for us as nurses, but we have to try and look past our own assumptions and meet the client where he/she is.

[systoly]

Just a thought: fear/anxiety

[AngelfireRN, MSN, RN, APRN]

Well, is it stupidity, or is it a cultural difference (husband makes decisions for the family)? Is it stupidity, or the normal grief reaction of denial to a frightening diagnosis? I understand it can be frustrating for us as nurses, but we have to try and look past our own assumptions and meet the client where he/she is.

No, that was my first thought (cultural diffs, that is), but these ladies were both American. And lady #1 had pre-empted her case with the same instructions that she gave the cardiologist after he told her that she needed a transfer. That was what was so mind-boggling to me.

Then again, I'm a big women-libber, and I make my own decisions, so maybe I'm the wrong one to ask.

[VivaLasViejas, ASN, RN]

The generations of women before ours (Baby Boomers/Gen.X, Y, Millenials etc.) were generally submissive to their men. They didn't usually hold the purse strings or make the decisions in the family; it was "I'll have to ask my husband" whether it was buying a vacuum cleaner or going out with friends.

We, of course, find that quaint. But that's the way it was for millenia before us, and for many elderly patients it's never going to change. That may partially explain their reactions.

[Cherybaby]

My first thought was fear and denial. Those are frightening things to tell a patient. I know when I have patients who get cancer diagnoses (skin cancers) they tend to be very reticent to get treatment right away. Some need to think it over and let it settle in their minds first.

I don't think these people are stupid or clueless at all. They don't have the medical knowledge that we have and it is very intimidating for some.

[dianah, ASN]

We review with the pts (and spouse, if possible) before the cath the four possible post-cath scenarios, just so they'll be prepared, and not be caught by surprise with transfer news:

1- no CAD

2- some CAD, medical management only

3- CAD requiring PCI/intervention (emergent VS elective)

4- CAD requiring bypass surgery (emergent VS elective)

Hopefully the Cardiologist has explained to both pt and spouse the same.

Again, so they're prepared for the next treatment step.

No surprises, as much as possible.

Sometimes, in dealing with a pt processing the news he needs an urgent PCI (that stunned look on the face tells it all), I will gently try to tie it all together with "you KNEW something was wrong, didn't you? That's why you went to the doctor in the first place," and this usually opens the door for some venting and communication.

Then again, ppl (including myself in this ) have a tendency be overwhelmed by a lot of information overload, and may not internalize/understand the ramifications.

We're all human. :)