How do you get a stubborn patient to COMPLY

[sasha2lady]

I have a pt who is in his mid 60s, heavy smoker, "closet" alcoholic. He has constant c/o nausea, vomiting, diarhhea, heartburn and chest pains. He takes flomax, norvasc, prilosec, and another bp med that starts with a b...I think its bystolic. Anyways....I have never actually seen him vomit ....but he will swear up and down hes hungry take 1 or 2 bites and then belch til it nearly gags him ..but no vomiting. Ive never seen him have diarrhea and the chest pain I think is heartburn....along with his regular c/o heartburn. He doesnt take his meds right..he says that his bp meds make him dizzy and sick....so he takes them when he feels like it or he will half them if he feels like it. He thinks that if his bp is 130/60 then the bottom number is too low thus that "bp pill dont work". He went for a stress test and an echo of his heart...all tests came back negative including all of his blood tests. He lies when he goes to his doc...he told his doc he was having heart trouble....so thats why he had all those other tests...he didnt tell his doc about his NVD and heartburn...therefore he thinks that his doc doesnt know what he is doing or how to treat him...I tried to explain to him that when you go to your doc...you need to tell the md everything so that they will have a big picture to work with..if you only c/o heartburn and chest pains..thats the route of tx they will pursue. We got his wife to go to an appt with him and the doctor he saw said that he didnt want to hear anything the wife had to say b/c she was not the patient...therefore....a lot of holes were left in his tx. I suggested that he switch doctors or demand that this one hear what the wife has to say since this guy wont tell the truth. His son has told me that he has been like this for years and years and he seems to think its all in his head. I personally think that he should go for a colonoscopy and an EGD and a gallbladder ultrasound. Im starting to doubt this mans symptoms b/c of his nocompliance. At this point, I would think the md would aim at looking at 1. the gallbladder 2. hernias esp hiatal 3. ulcers 4. colon polyps or cancer. Why wont his doc listen to his wife???? I was taught in nursing school that you can take info from not only the patient but from familiy if the situation so applies. I think in this case it does.....I am at the end of my rope to try and help him find answers but I cant force him to do anything. How can I get him to comply??????? ...even though I seriously doubt he will do anything for anybody until it gets to a point that he cant avoid help.