patients who LIE about their symptoms!

[HappyNurse2005]

Had a pt w/ cardiomyopathy, EF 40%, CHF, htn, etc. In for exacerbation of CHF. Pt of internal med residents and cardiology. Pt was having short runs of vtach, 5 to 8 beats. Asymptomatic. well, at first!

TUrns out she was feeling weak and having "funny feelings" in her chest during these runs, but lied about it b/c she wanted to go home.

She's getting an AICD

Edited to add/clarify:

I now realize that it really doesn't matter who pays for it, so i deleted that sentence. That's not the point of this thread, nor was it to be snarky. It was simply complete surprise that said pt would lie. This is a woman who is already sick. Quite the cardiac history, plus copd/asthma/smoker. (point of all this being-she's sick)

I can see people who've never been sick before denying it, b/c they don't understand. This is someone who is already quite chronically ill, I would think that someone already with cardiac disease would value the importance of getting not lying about heart problems.

THe point of this is being surprised/not understanding. Not to be snarky.

[begalli]

Yes, you're right about the facesheet.

But what about the lady who can't afford an AICD and needs assistance paying for that? Did she get a consult as well and why the comment about taxpayers paying her bill but not that taxpayers are paying for the plavix?

There must be more to the original post that makes you obviously offended that the taxpayers are paying. Was your patient an IVDA? What, in your mind makes her less deserving?

-NOT saying IVDA does not deserve.

[begalli]

As a proactive nurse, who cares for the whole pt and not just their medical condition, yes, i make sure my pt has resources to pay for their medications. How effective is it to fix their medical condition if we throw them out to the wolves with no way to maintain?

Proactive for ALL, right?

[begalli]

Edited to add/clarify:

I now realize that it really doesn't matter who pays for it, so i deleted that sentence. That's not the point of this thread, nor was it to be snarky. It was simply complete surprise that said pt would lie. This is a woman who is already sick. Quite the cardiac history, plus copd/asthma/smoker. (point of all this being-she's sick)

I can see people who've never been sick before denying it, b/c they don't understand. This is someone who is already quite chronically ill, I would think that someone already with cardiac disease would value the importance of getting not lying about heart problems.

THe point of this is being surprised/not understanding. Not to be snarky.

I just noticed your edit.

What I think you need to understand is that there is a HUGE difference between lying and denial.

Is this more about people's personal choices (like smoking) when they have a diagnosis of COPD?

Does it strike a nerve that even though these types of patients make bad choices - preventable exasperations - they still do what they do and the bill ends up lying squarely at the foot of gov assistance (us) which includes many of us who may make different choices?

[KellieNurse06]

Who cares who is paying for the darned thing ???? I think that's irrelevant really....................what ever happened to just plain old caring about people in general? God forbid the person who worries about what type of insurance someone has or who is paying for something healthcare related.........you could be in the same predicament someday ....you never know. Never judge because it could come back to bite you in the butt tenfold.........I think with all the craziness going on in our world today that the type of insurance one has is pretty irrelevant considering..................... Boy I must be a bad bad person because my child is severly disabled & has medicaid......and I don't even want to know what her medical bills are up to so far............this scares the crap out of me when people think this way.........sometimes things happen in life that we have no control over..............that's just the way it goes...............:stone

[HappyNurse2005, RN]

Yes, you're right about the facesheet.

But what about the lady who can't afford an AICD and needs assistance paying for that? Did she get a consult as well and why the comment about taxpayers paying her bill but not that taxpayers are paying for the plavix?

There must be more to the original post that makes you obviously offended that the taxpayers are paying. Was your patient an IVDA? What, in your mind makes her less deserving?

-NOT saying IVDA does not deserve.

does IVDA mean IV drug abuser? I don't know. Don't care. And I did have a social service consult put in on her, I did talk to the case manager about her, and did request the docs to write her 3 day RX's so we could fill them. Asked her if she had a way to pay for her meds.

I never said she deserved less. Please see my original post, and the edited comment. The taxpayers buying her an AICD comment was probably not appropriate and not at all relevant. that was only made so a reader of thepost would know the outcome of this situation (that she needed a device, and that the lying could have had her sent home and end up dying).

Honestly, the only reason I said "the taxpayers are buying her an AICD" was b/c I was getting ready to type "she bought herself an AICD" and then thought as an afterthought "oh, wait, she's not paying for it". the fact that she was poor didn't matter, the fact that she was self pay didn't matter, that comment had no significance to my statement about her lying.

To me the comment had no significance except for the statement that she was getting an AICD. Obviously, i presented that statement in such a way as to detract from my point.

sorry for any misunderstanding.

[begalli]

I'm really glad you clarified what you meant. Because really, it did sound really really BAD.

[Ruby Vee, BSN]

patients lie. they may lie to you, the doctor, the triage nurse.

otoh, some folks lie because they're in denial. or they're lying to themselves more than to you. or they're trying to be strong, because compared to that guy across the way who just got his left leg cut off by a drunken buddy with a brand new chain saw, they really aren't that sick. are they? (oh, please tell me i'm not that sick!!) or they just thought of a symptom that they really didn't think was a big deal, but now that you're here asking them about it again, it must be a big deal so maybe they should tell you.

best you learn to read between the lines, because believe me, it's going to keep happening!

[toadie]

reading this post and all the replies i just had to respond. i don't think the op meant anything mean by saying her pt was "lying". i think op was just trying to voice her frustaration with trying to take care of a pt who was not supplying all the needed information to fully take care of her. it's frustating to think you are assessing pt and managing their care appropriately just to find out there's is a lot more going on.

whether the pt "lied" or "fibbed" we as nurses just want to see them get better. it's just frustrating when we don't have what we nee(information).

just me 2 cents

[Antikigirl, ASN, RN]

I find that patients deny, gloss over truths, simply forget, don't find the importance of, or down right lie. Gee go figure they are human!

All the time however, there are reasons you may not see up front. Some people are intimidated, or don't want to bother anyone, some are stressed, some simply don't remember unless you trigger the memory or act a direct question. Some are scared of finances or pain or longer stays in hospital. Some are scared of worrying their loved ones, or feel they must get back to work or home to continue their care of loved ones. Some are scared of angering or getting a lecture from a healthcare provider. Some are afraid of getting in trouble from the law or other organization (like CSD). The list goes on...

Now, I am not a mind reader nor am I such an empath that I can tell if someone does this all the time! My questions to patients must be simple, and cover a broad scope of things in short order...so I do find that patients must take responsiblity on their own as well to provide the best information they can so that their healthcare providers can do the best for them.

So if a patient denies or coats the fact they have had chest pain, even through my many questions about it (do you have any pain, pressure, numbness or tingling...and most often I also add heartburn because some people feel that chest pressure or discomfort is heartburn or stomach upset...so best to ask) then there is nothing more I can do but chart that, watch body language and conversation style (are they sounding unsure, stammering, pausing, looking to the left or not at me...etc), and document what I heard. After that, it is the patients responsiblity to tell someone about their symptoms if they persist. That is one thing I certainly can't do for them since I am not them!

Yes, I get lots of patients that deny pain just to go home, and many times I can tell! You just do your best to try to see through to the truth of the matter regardless of why they may not be telling you.

I also find it helps to have some handy questions available like "does paying for this worry you?"..., "are you worried about work/taking care of children/loved ones?"..."do you feel comfortable about your pain levels once you get home and more active?"... "do you have any questions about your privacy rights or patients rights?"...etc. Sometimes that can be a preemptive strike against some of the risks to not giving full info .

[dawn30]

It has been my experience that patients, especially eldery pt's, tend to downplay their symptoms in many cases because of denial, fear and in some cases because they don't want to frighten their families. My grandmother, who suffers from COPD, always downplays her symptoms to me. ("I think I'm just getting a little cold")... she NEVER wants to admit that she is really ill and needs to be in the hospital. I don't think that I have ever considered her downplaying as lying to me, I just know that she has been thru sooo much in the past thirty or so years with her disease that every day spent out of the hospital is a huge milestone for her. All you can do is watch and use your best judgement. If you feel that your pt is not giving you the full picture, assess until you drive them crazy enough to tell you what they're really feeling. That's what I do to Grandma... drive her nuts until she goes to the DR. and he confirms what I've been saying all along and admits her butt.

[traumaRUs, MSN, APRN]

Compassion and empathy and a smile go a long way with all patients. Denial even in the chronically ill is very common.

War story: Had a young guy in his 20's come into the ER c/o abd pain (he was still in his street clothes). I asked if he had any medical problems and he said "No, I'm healthy as a horse!" As I'm getting his shirt off I see the unmistable open heart scar down his chest and I asked what happened and his reply was that, "Oh, that was from the heart transplant I had about 5 years ago - I've been healthy as a horse since then." tee hee hee

Was he lying? Nope - that was his reality.

[GooeyRN, ADN, BSN, CNA, LPN, RN]

I had a pt say she was feeling better just so she could be discharged. She wanted to go home. She was still quite sick, but the lol did not have time to arrange for someone to care for her rottweiler.