Patient education frustration

allnurses Guide · Jan 20, 2015

I think it's pretty much the norm. It takes a long time to begin to establish in your patient population what truly appropriate treatment is. It does get better.

I have at least one "argument" a day about abx. Our local EDs all use PressGaney and every patient gets an abx which makes it hard.

I recently had a DM patient that I have been trying to get on an injectable for years come to me and ask about "that new weight loss injection". She is willing to do injections for weight loss but not her diabetes.

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anh06005, MSN, APRN, NP · Jan 20, 2015

Following to see what everyone else says. I'm interested in ways to kind of hold people off of abx for the sinus symptoms they've had for 4 hours.

And don't they have a diabetic injectable that has been shown to have weight loss as a side effect???

This issue is one of the most aggravating of all healthcare. Doing home health I will have a COPD frequent flier who can't afford her $5 antibiotic for pneumonia BUT can afford the marlboro blacks sitting at the top of her purse. Love it.

Jules A, MSN · Jan 20, 2015

I do think part of the OP's experience might be secondary to the cultural norms of that patient population although in general our society as a whole does seem to want the quick fixes for everything. I have no problem being fired for not prescribing what a patient wants if I feel it is contraindicated and in psych of course that largely means stimulants and benzos. :)

scottaprn · Jan 20, 2015

Despite a crackdown in 2010 Antibiotics are still readily available in Mexico without a prescription. This study says 65 percent of the time no prescription was needed. Mexican Pharmacies and Antibiotic Consumption at the US-Mexico Border

allnurses Guide · Jan 20, 2015

Everybody wants instant gratification in the form of a Z pack. I now simply tell patients that what they have is viral, and an antibiotic won't make them feel better, and here's what you can do to treat your symptoms. End of story. There are some that are willing to listen to the concept of bacterial vs, viral, but most patients just aren't interested. There is a physician in my practice who likes to make his patients happy. Everyone with the sniffles gets an rx for an antibiotic, often with a refill. Every asthmatic who has a tiny cough gets an rx for a Medrol pack with a refill. I'm covering for him this week and his "regulars" are not happy with me, cause I don't dole out meds freely. I'm "mean". So be it.

coast2coast · Jan 20, 2015

I'm a FNP in CA and work in a rural, community clinic. Most of my patients speak Spanish and are farm labor workers. I find that when offering education regarding viral vs bacterial, DM diet education, diet and exercise, my patients are extremely resistent. They only want an antibiotic for whatever ails them. They don't want education. They simply want a pill to make it better. I've been here for awhile and am becoming discouraged. Is it simply the patient population I work with, or are most people simply wanting medication and don't care about learning about their health?

I work with the exact same population, and have learned a few things the hard way. Some things to think about:

- how are you communicating? do you speak spanish or with a translator? do you understand what your translator says? are you sure? an uninformed MA passing along bad info can cause major problems.

- I guarantee you need to simplify what you are saying by 1000%. For my typical spanish-speaking, somewhat literate, recently immigrated patient with a URI I tell them "you have an infection but antibiotics won't help." PERIOD. that's it.

- if you are going to deny antibiotics (and I almost always do), be sure to offer something else instead so they feel like they got "treated." be extremely sympathetic. I give out a lot of claritin, ibuprofen, and robitussen this time of year.

my full URI script is something like "You have an infection but antibiotics won't help. Everybody is getting sick with this infection right now and I know you don't feel good. I am going to give you medicine(s) to help you feel better. Your body will get rid of the infection in a few more days."

- be liberal with cough syrup. they will live without penicillina if you give them a way to sleep at night. I will script out 10-15ml of the good stuff with promethazine/codeine if I know them and they don't have substance abuse issues.

I am going to follow up with another post regarding diabetes, just to break up the topics a bit.

coast2coast · Jan 20, 2015

They don't want education. They simply want a pill to make it better. I've been here for awhile and am becoming discouraged. Is it simply the patient population I work with, or are most people simply wanting medication and don't care about learning about their health?

I could write a book on the california immigrant hispanic population and education and diabetes. What I have learned so far:

- Culturally many are taught to be extremely subservient to doctors/providers. They won't ask questions because they want to make you happy. they will agree with everything you say (to your face) and then go home and do what they want. (they're human !)

- Learn to ask about their reading level. Can you read the label on the bottle, or does someone else do it for you? You will be horrified at the answers to this question.

- Many immigrants lack even the most basic science/biology education. I know most of my latina ladies stopped going to school somewhere between 3rd and 5th grade; a few finished high school.

- with that in mind, think about how you talk to them about diabetes. before you even get into diet and exercise, TELL THEM WHAT IT IS. "when you eat food, you digest it and it turns into sugar in your blood. a little sugar is OK. too much sugar can be like poison in your circulation. it hurts organs like your heart, kidneys, and eyes." " i am going to give you medication to protect your organs."

- tie it back to the ever-present "gastritis !" and whole-body pain. "when sugar is too high, it messes up your digestion so your gastritis feels bad. your muscles start to hurt because of all the sugar in your blood." for men, tie it to erectile dysfunction. they will do anything you tell them to after that .... !

- they will go a long way with a little education, but much of what we say goes over their heads. simplify, simplify, simplify and go VERY slowly. you can't diagnose someone with diabetes, start them on meds, and provide DM2 education all in one visit. even if you had unlimited time, no one can absorb that much information all at once. break it up.

- simplify med education. "please come back and tell me if you don't feel good when you take this medication. if you get bad stomach upset, or dizziness, let me know."

- make sure compliance issues aren't really literacy issues.

- many believe that insulin will make them sicker, or make them die, because the only people they know on insulin are terrible diabetics. they also believe that diabetes comes from being badly scared one time, and will often relate traumatic experiences to you at the time of diagnosis. don't be dismissive of this as it will undermine your credibility in delivering the diagnosis.

- mention weight loss with metformin, and pleeeeease titrate it slowly if you are going to 1000 BID so they don't get awful vomiting/diarrhea and refuse to take it ever again.

- frame basal insulin as a way to avoid TID insulin. tell them the better they do with diet, exercise, and PO meds the longer they will avoid insulin for.

- make sure you are dosing sulfonylureas when they are really eating; many only eat one meal a day and then feel terrible with 10mg glipizide and no food.

- always, always keep in mind financial and job insecurity and how they impact food choice, meal frequency, and exercise. can you imagine working 80 hours of hard labor and then being told to exercise?

- when starting meds, tell them they will FEEL BETTER. Many deny feeling sick at all at the time of diagnosis, with a1c 10 or 12 or 15. " i know you don't feel sick, but as you start medication your energy level is going to improve over the next few weeks and months. you will start to realize that you weren't feeling that great and that medication is helping. your vision will change a lot but don't worry about that right now, it will settle down. your digestion and your sleep should start to improve."

- for those that travel seasonally, please be aware that there is a magical line at the border which absolves them of their diabetes and their need to take any medications. tell them, over and over again, that they have to stay on medication even on vacation. it sounds simple to us but you have no idea how many of them stop all meds as soon as they get home, because they're only diabetic in america.

sorry for the text dump. as you can see this is my "thing" and i know how frustrating it can be. it will get easier !

travelcrazyRN · Jan 20, 2015

My first thought was similiar to the poster above. Do you speak Spanish? Is any written material printed in Spanish at a very basic education level? I don't want to degrade this population of people but education has not been their priority and I think their only goal is to feel better as fast as possible as a matter of survival.

allnurses Guide · Jan 20, 2015

And don't they have a diabetic injectable that has been shown to have weight loss as a side effect???
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Yes. It's the same medication (and class as several others) in a double dose. On top of that there are also two classes of oral agents with significant weight loss. But they won't take those because they are for diabetes.

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lhflanurseNP, APRN · Jan 20, 2015

Yes. It's the same medication (and class as several others) in a double dose. On top of that there are also two classes of oral agents with significant weight loss. But they won't take those because they are for diabetes.
It amazes me what motivates patients! I believe that is one of the most important things to determine. I once had a practitioner tell me to find out about the patient's social and family life...what drives them, what are their concerns. If dealing with women, they rarely think of themselves, but you may find the motivator in "your son graduation from" or "see your grandson get his first".

anh06005, MSN, APRN, NP · Jan 20, 2015

Yes. It's the same medication (and class as several others) in a double dose. On top of that there are also two classes of oral agents with significant weight loss. But they won't take those because they are for diabetes.
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Wow. Some people.....but yeah won't take the oral agents that may help them shed pounds. TOTALLY makes sense (sarcasm).