Patient non-compliance

hoolahan, ASN, RN · Apr 27, 2002

Yet, on another thread, when a doc threatened to discharge his pt's who continued to smoke, people cried unethical? Hey, I am a firm believer of doing the assessments, making the referrals, and when/if it becomes eveident a pt will not try to help themselves, I discharge them, and fully explain why to them, and their doctor. Even so, I still say there are less people actually like that than people who are only like that for other unknown reasons.

The CABG pt who smokes? Hey should have been denied surgery until his nictine levels were down, same with morbidly obese and. heart surgery, that only increases risk factors in the post-op period. These pt's should be told to loose weight. BUT, preventive health care IS NOT COVERED BY INSURANCE!!! If my insurance company would pay for me to go to the gym three times a week, I probably would do it. If they paid for nicaderm patches or hypnosis or alternative therapies for quitting smoking, who's to say more people wouldn't be compliant if those circumstances were present??

Yes, one has to be motivated, but there has to be a support system. If our countries medical support system would promote health maintenance instead of illness, we'd all be in a better place.

Fgr8Out · Apr 28, 2002

"Non-adherence" is certainly a frustrating issue. In my own practice, I do my best to explain the rationale to my patient, give them information and resources to assist them and then leave the rest up to them to follow through.

It's not perfect, and it certainly doesn't address the many other issues concerning health care costs, insurance and the like. But I have a clear conscience because I'm doing my part to do right by my patient. Even if they don't adhere.

Peace:)

Jenny P · Apr 29, 2002

I'm overweight (or else too short, depends on your viewpoint). When I saw my doctor for my yearly physical, did he even MENTION my weight? No. My cousin, on the other hand, was told by her doctor that she had to lose the 5 pounds she'd put on over the last year, and she is physically fit and has never had to worry about her weight.

I'm a stress eater and my doc knows it; and since he also is my hubby's doc, he knows us fairly well and some of my stressors! Am I non-compliant or non-adherent? Do I know better than to be overweight? Yes. I have told my doc that I need to lose weight and he's never said even a word of encouragement about it to me (and I'm 30+ lbs. overweight, people; not some anorexic so-and-so). He tells me my BP and lipids are all normal; maybe if they weren't it would help. I NEED MOTIVATION in order to lose; but am not getting it from my health care provider!

NH-Viking · Apr 30, 2002

In general, the issue of non-compliance is consisitently found in the well-insured. Think about how often you have seen this.

Also consider this. Auto insurance companies make adjustments according to one's driving record, good or bad. Life Insurance companies make adjustments according to one's habits and behaviors, good or bad. Maybe it is time for health insurance companies to apply some of the same adjustments to those who truly don't intend to participate in their own well-being, and at the same time reward those who work hard at maintaining or restoring good health.

Psycho-babble aside, there is a large contingent of the American population who will soak the system for what they can, and not take any personal responsibility.

Rustyhammer · Apr 30, 2002

There are many out there that honestly feel that they are "owed" the health care that they recieve and going to the hospital is the fix for whatever problem that they have that day.

It isn't their responsibility to take care of themselves, that's the Dr.s job.

I think this may be the result of generations of free health care that this country has doled out over the years. The uneducated and poor wont even THINK about quitting smoking as an option or losing wt. (" My mother was big, I'm big and my girls will be big...thats the way it is, why bother changing my life?").

I think that sometimes the non-adherant pt. is just unable to comply. Some never figured they'd live this long anyway.

-Russell

TIREDmidnightRN · Jun 1, 2002

It is aggravating to have to deal with repeated admissions that were preventable..but on the other side, I remember two residents discussing a patient with disgust because the client insisted on being a "full code" and the doctors felt they knew best, that THEY knew the "quality of life" was inadequate! If we allow doctors to dictate "compliance" we may be allowing them to dictate, period!

There is also the issue of prejudice! One nurse mentioned weight..it is becoming the new target politically.....for many years I have seen the cardiologists chastise, insult, cajole..and even refuse to treat overweight FEMALES....(some who were only overweight by the insurance companies strictest Guidelines) while MALES who needed "bigboy" beds and were too heavy for the cath table were NEVER heard a word about weight. Give the docs more power, and some will subconsciously discriminate!

SmilingBluEyes · Jun 1, 2002

OMG don't even get me started here......ya see it ALL the time in labor and delivery nursing. I have to admit, it is one of the MOST CHALLENGING aspects of my job. It really makes it hard to treat them well and fairly when they blatantly ignore your best advice and sincerity......***sigh*** oh well......i could go on and on...but to what end?

NH-Viking · Jun 6, 2002

Well, as I suspected, there are many of you as disgusted with non-compliance as I am. Collectively, I think it is time to make this more of an issue. If we don't, it will drain the system dry. Allnurses.com is a great place to start. If we keep this going, maybe the media and government will take notice.

Expect resistance from hospitals, the industry, and doctors. Non-compliant patients are the bread and butter of health care economics.

In addition, try posting your views on http://www.turkeytrail.com. I did.

IT'S TIME TO MAKE PEOPLE AWARE!

Mark