Patient non-compliance

NannaNurse · Apr 26, 2002

Boy, I have to agree with you here. I've cared for so many patients, medicare patients who were in rehab for specific assistance and would not comply. The Director 'expected' us to make sure they did their daily therapy, etc......like we are magical or something? I can only do so much. To me, if a patient states "NO", then that means just that! I'm gong to chart what they said and let the MD know. If they continue to refuse, then they should be discharged!

The big problem that I have seen is that facilities want that 'almighty buck' and will make attempts to 'make it look' like the patient is cooperating!

That is why big chunks of MY check are taken each month...to pay for things like this.

If the patient doesn't want to follow the directions/advise of the MD and/or medical staff......GO HOME!!!!!!!!!! We need the bed for those who do. :mad:

fergus51 · Apr 26, 2002

I get mad with those who don't follow medical advice too, but I am NOT in favor of rationing health care based on that. When you think about it, most diseases like diabetes, MIs, liver failure and certain cancers are at least somewhat preventable and I don't want to go down that blame road.

Jenny P · Apr 26, 2002

There is another consideration here, the fact that some pts. are non-compliant because of things beyond their control-- illiteracy; side effects of drugs that MDs don't want to deal with; poor health teaching; poor cognitive thinking; fear; etc. I thought of most of these just from dealing with recent family illnesses where it LOOKED like non-compliance but there was something else going on. I would hate to be labeled non-compliant when a med makes me sick and the doc is unable or unwilling to switch the meds.

hoolahan, ASN, RN · Apr 26, 2002

Exactly JennyP. In home care you see a whole different side of the picture of non-compliance. Spanish people have med bottles with English instructions on them (please don't start the argument of everyone should speak English, when it comes to meds, and a pt goes to a clinic called "Centro Medico", it should be written in Spanish!)

I disagree with selective treatment also. If someone is non-complaint, a social worker should be sent out to identify what barriers there are for this person that keeps them non-compliant. I had one pt who was in and out of the hospital so much, he wouldn't let us fill his mediplanner, but when I became his case manager, I insisted, and we agreed he would try it. Well, he's been out of the hospital for 2 months now, the longest stretch in a long time.

I think that part of the reason that pt's are non-complaint is that they lose faith in the medical system. I can see why. Many patient's who are on Medicaid are not taken seriously by healthcare practitioners. They are lumped into the category of "Medicaid Leach" and so, their complaints and issues go unheard. I have to beg to get a doctor to send a refill for diabetic testing strips and lancets. I have been after one doctor for over 2 weeks to send them to my pt, and this pt tests himself regularly, but they blow him off b/c, I believe , he is Medicaid. How can someone be complaint if they don't have the tools to do so??

I know there are people who suck the system dry, that is b/c they are allowed to. It's easier for some healthcare providers to give in and give that Rx for pain med, instead of determining why a person has such uncontrolled pain. I have experienced many docs and other healthcare practitioners who blow off a pt concerns as soon as they hear Medicaid. Yes there are some select few who suck the system dry, but to categorize everyone w/o a social and environmental assessment is unfair.

WashYaHands · Apr 26, 2002

I agree with Hoolahan and Jenny P. In some cases the nursing diagnosis of Ineffective management of therapautic regimen is more applicable than that of noncompliance. It's not that they dont want to comply, it's because there is some barrier that prevents them from doing so.

On one occasion, in an effort to make a point to an MD I took a patients discharge orders and looked up the cost of all of their discharge meds and added them up. The cost per month for all the meds ordered was $256.00. This figure was based on wholesale prices and didn't include the pharmacy markup. This particular patient was elderly, living on social security and expected to pay $256/mo. for meds.

On the other hand, I've worked in rehab, so I can understand what NannaNurse is saying about patients refusing therapy. In situations like this, I think it is the responsibility of the entire team (MD, PT, OT, nurse, family, and patient) to address the problem and find out why the person lacks motivation.

Linda

NH-Viking · Apr 26, 2002

Thanks for your responses. You all bring up valid points. Perhaps if I pointed out examples, it would be helpful. The "patients" I refer to are diagnosed with disease and simply not interested in taking responsibility for their health. We've seen this in many socio-economic ranges. I've seen white-collar workers who continue to smoke, over-eat and not take their Rx's after a CABG. Those with diabetes who use diet and insulin to control their sugar when they "feel like it". COPD and asthma patients who state they will "never" quit smoking. I'm sure you are understanding now.

Those who are truly ignorant of what they should be doing need our help. Those who are not, why waste the time and money? Give it to those who can't afford it, but will remain compliant. The well-insured are the worst abusers, but unfortunately these are the bread and butter of the health care industry.

We all know patients who suck the system dry.

CseMgr1, ASN, RN · Apr 26, 2002

When I was in home care, I was told by more than one of my patients to "mind my own business!", because they didn't want to HEAR what they already knew: they had NO intention of following their doctor's orders (or mine). Of course they were discharged, becuse Medicare guidelines mandated it, if we were documenting noncompliance with an AWARENESS of the consequences. Only weeks later, John or Mary Smith wound up BACK in the hospital...and with another home care admission. But, with the advent of the BBA (Balanced Budget Amendment of 1997) and the arrival of the dreaded DRG's to home care, it not only served to shut down a lot of home health care agencies, but also helped to "weed out" those patients who were more interested in having their backs rubbed...than taking their medicine. Sadly, it has also prevented those who want to get better, from getting the care they need......

susanmary · Apr 27, 2002

I believe the politically-correct term is now "non-adherent."

hapeewendy · Apr 27, 2002

if a patient is non compliant for reasons like lack of understanding, lack of resources or somehow lacks the ability to be compliant in some other way then thats a different issue entirely

and the healthcare system, unfortunately is at fault in those scenarios..

but the people that choose to disregard instruction ,health teaching , medication regime's etc just get me so pissed at times.....

I know , I'm a nurse, I'm here to provide a service to those who need it without prejudice...

but I'm also human and seeing the frequent flyers that could have avoided yet another trip to the ER and yet another week long stay in my med surg unit just rub me the wrong way....

a nursing professor of mine was famous for always saying "an ounce of prevention is worth a pound of cure"

and truth be told that when I'm nursing these ppl who show blatant disregard I am thinking to myself that I am probably wasting my breath when i waltz into the room and do my nursey nurse health teaching bit

but I still do it,I'm still optimistic that some how I will get through , and somehow this person will change and understand the importance of helping their own health along and the role that they play in their own lives...

sometimes I am in favour of user fee's for our healthcare here ....other times I realize that that probably wouldnt make a difference

and that some ppl just dont "get it"

NH-Viking · Apr 27, 2002

Seems like we all are concerned. If you think about it, the whole system is dependent upon non-compliance. If the same people didn't keep returning to ERs, hospital beds and offices with the same problems, we wouldn't have much to do.

I did find a website called TurkeyTrail.com. The author of this is looking for stories of non-compliance. It is a busy site but there are a couple of good examples. Let's talk this up some more!

NH-Viking · Apr 27, 2002

In my last posting I meant to say that this turkeytrail site is not a busy site. Sorry for the confusion.