Patients who don't follow Dr's advice

[disneysteve]

I don't usually complain about work here, but I just saw a patient who always ticks me off. Without revealing any personal info (HIPAA, you know), this individual was in a accident 10 months ago. He has since come to see me on several occasions complaining of the same pain each time. Each time, I order tests and schedule a follow-up visit. He never goes for the tests and never shows up for the follow-up. But he turns up at my office 2 or 3 months later with the same complaints. I don't know what he expects me to do. Either get the tests done or stop coming to see me.

I realize I can't help everyone, as hard as I may try. I just don't know what goes through people's heads in a case like this.

Sorry to rant. Nice to have somewhere to do it, though .

 

[AlwaysAPrincess]

DisneySteve....
I can relate. It is truelly amazing how patients continue to complain visit after visit & yet do NOTHING they are told to help themselves. We all go through those days & then you have that one patient that calls to thank you for helping them. Just keep a note of their non-compliance.

Hope your day gets better. Think Disney thoughts

 

[disneysteve]

Hope your day gets better. Think Disney thoughts

Oh, I certainly don't let stuff like that ruin my day. And I ALWAYS think Disney thoughts. Why do you think I'm posting to DIS in the middle of my workday?

 

[Pooh67_68]

My cousin's diabetic doctor tells everyone who is going to be his patient, if you are not going to listen and do what I say don't waste my time and leave now.

 

[Tinkim]

I type for doctors and I have often wondered if they get "frustrated" with the noncompliance. I usually shake my head while I am listening to it so I figured it must make them crazy.

 

[I_Know_You2!]

My dad who is semi-retired, fires patients who do not comply within reason!

 

[The Mystery Machine]

My doc's office would ask me to have the tests done before I was scheduled to see them in their office.

 

[Puffy2]

DisneySteve,

Some people are just that way. Stubborn. I am a nurse and I've seen all kinds.

But, there might be a reason why he's not going for the tests - have you asked him?
I don't know what you have ordered, but I've known people to be afraid to go for a CT because of the cost of it (they might have a high deductable- or insurance only pays a part of it and perhaps the part they will have to pay is high for them) OR if they have to be injected with dye, they might be afraid to be injected (fearing allergic reaction). I've also had people not go for a CT because they didn't understand what a CT was and why the doctor was ordering it -it wasn't explained to them before they left the office.
OR, maybe they are a little "dense" and really don't know how to go and get the tests done (directions to the lab/xray facilities, etc...)

There could be all sorts of reasons that maybe you haven't thought of yet. and he probably isn't coming in for the follow up because he "feels better" - you might need to explain to him why the follow up is important.

It's hard to see a gazillion patients in one day, but sometimes things get rushed, and we assume people understand things that they don't. It helps to take the time to make sure all their questions are answered.

Here is a funny story - my young daughter came through the kitchen one day holding a rag to her face. My husband asked her "is that towel clean?" She said "yes" and went upstairs. Being suspicious, I followed her - only to find her in the bathroom with a beet red face. What happened? I asked. She had sprayed poporri (sp?) oil on her face by accident, thinking it was perfume. It was burning her face! Well, into the shower she went, and after telling my husband about it, he admits "I guess I asked the wrong question - instead of "is that rag clean?" I should have asked "is your face on fire?????"

 

[Microcell]

I only work for docs too and feel your pain, as they don't follow directions and then want to be seen RIGHT NOW after missing the follow up appt. They call in acting like they are dying and I think to myself, why didn't you come in two weeks ago when you were scheduled? I also have to write up all the symptoms for the doc so they can assess if they should get in! We now have a follow up log since we have glaucoma patients so they get letters galore from us!!

 

[Pea-n-Me]

I am a hospital nurse too and for 9 months this year I was also a patient - *that* was an interesting experience!!!

I tried to be a good patient, though.

 

[gshoemate]

My MIL. She has a back injury from helping a patient into bed (home healthcare). The doctors have tried to get her off pain medication and tell her things to do to help with the pain but she makes excuses. The doctor told her that doing exercise in the pool would help her alot but she claims she doesn't have time. She is retired and doesn't do much but sit around the house. Then their is my FIL who had a triple bypass a few years ago. He is back to eating fatty foods and smoking. He looks like he is 9 months pregnant. It is very frustrating that they waste the doctors time and don't do what they are told.

 

[disneysteve]

gshoemate - Patients who don't want to do things to help themselves can be frustrating but is quite understandable. Its tough to quit smoking. Its hard to reform your diet or start an exercise program.

What I was referring to in the original post was a guy who won't even go get an x-ray done. Nothing difficult, scary or mysterious about that. He hurt his shoulder in a bus accident, keeps coming in complaining of pain, but can't seem to go get a simple x-ray. This same guy, at a visit in July, asked me if he could get some bloodwork done (routine stuff - sugar, cholesterol, etc.). We scheduled a bloodwork appt at my office the following week. He didn't show up. At today's visit, he again asked if he could get bloodwork. So not only doesn't he follow my orders, he doesn't even show up for tests HE requested.

Puffy2 - Everything you say is true, though none of it applies in this particular case. I, too, have seen all kinds after nearly 15 years in practice. Many times there are hidden reasons for non-compliance, as you mention. For example, many patients stop their meds or take them only periodically because they can't afford them but are too proud or ashamed to tell me. So we often have to do some detective work to get to the bottom of things.

 

[Stepharoonie!]

I know EXACTLY what you mean. In a few weeks, I've seen more people who do NOT do what the doctor tells them, and then they come back all upset because their treatment isn't working. Sheesh!!

 

[delilah]

I'm a doctor, too, and of course, have my share of non-compliant patients. I have discussions frequently with the other doctors in the office about patients who won't do the tests we've ordered. One thing that really gets me, and I don't like to complain about work, either, are when you have a seriously ill patient, like I do now in the hospital, and all of a sudden, relatives that you never knew existed appear on the scene and want to call all the shots. This lady has been my patient since I finished residency and opened my practice 13 years ago. She lives with a daughter and her husband who are very attentive to her. She has been through colon cancer, breast cancer, bad COPD, CHF, renal failure, and I have seen her on a regular basis through the years. The only relatives I have ever seen with her are the daughter and son in law noted about. She has generally done pretty well the past few years, but, sooner or later, one of her many problems are sure to do her in. This time, it's acute renal failure. Instead of approaching me with a respectful attitude, a second daughter accompanied her sister and the patient with a list of rudely and aggressively stated demands. Hey, doctors are human, and, normally, if you ask me nicely, I will try to accomodate you. Try to intimidate me, and, well, no way, sorry Charlie, no dice. I have to continually remind myself that I really like the patient and her other daughter.

 

[jeleebeene]

My cousin's diabetic doctor tells everyone who is going to be his patient, if you are not going to listen and do what I say don't waste my time and leave now.

This is exactly what DH's Dr. told him - and so far, DH has followed his orders and advice. I think some Dr's just need to be that way after they have seen so many patients complain, and yet not do what they are told.

 

[Deb in IA]

I have no qualms about telling patients that I just can't help them anymore if they repeatedly do not at least try to follow my recommendations.

 

[MaryAnnDVC]

I have a relative who thrives on being sick. If she actually followed the instructions, there'd be 3 problems...1) it would be too much "work", 2) if she got better, she'd have nothing to complain about and she'd miss the pity party, and 3) she might actually have to function in life and be responsible if she doesn't have an excuse not to.

I wish more of her doctors (and she sees a bunch of specialists) would speak up as Dr Deb has suggested. Maybe this relative of mine would get the message and DO something for herself.

 

[disneysteve]

I have no qualms about telling patients that I just can't help them anymore if they repeatedly do not at least try to follow my recommendations.

Immediately after this patient left my office, I typed a letter to him stating that he has repeatedly missed appointments and failed to follow my treatment advice. I advised him that if he misses any further appointments or fails to go for the tests I ordered, I will be unable to continue as his doctor. I had told him essentially the same thing when he was in the office - just wanted him to see it in black and white so he can't claim I never told him.

Pooh67_68 - Many specialists do this because they are in great demand and don't need to spend time on patients not interested in getting better. Around here, it takes 3-4 months to get an appointment with an endocrinologist (diabetes specialist) so I would hope they aren't wasting lots of time on non-compliant patients while more motivated patients wait months to be seen.

 

[treesinger]

I must admit, I have a problem with compliance. I have diabetes II. I do try to maintain a diet as prescribed but have a terrible time with it. I'd say that I comply 70% of the time. But I'm a stress eater and I've got some serious stress that has been ongoing and will be ongoing.

I'm not defying doctor's orders for the heck of it. I just don't know how else to cope.

I say, if doctor's turn away patients for non-compliance, more power to them. Being a doctor is a noble cause. But it is also a business. And they need to protect their businesses.

 

[disneysteve]

I must admit, I have a problem with compliance. I have diabetes II. I do try to maintain a diet as prescribed but have a terrible time with it. I'd say that I comply 70% of the time. But I'm a stress eater and I've got some serious stress that has been ongoing and will be ongoing.

I'm not defying doctor's orders for the heck of it. I just don't know how else to cope.

I say, if doctor's turn away patients for non-compliance, more power to them. Being a doctor is a noble cause. But it is also a business. And they need to protect their businesses.

I just want to be clear. Patients like yourself are NOT the kind I'm complaining about. Doing all the right stuff is extremely difficult.

I'm referring to patients who don't do relatively simple stuff, like keep their appointments or refill their meds before they run out rather than a week or 2 after they run out (assuming they can comfortably afford them and have no trouble getting to the pharmacy). If you come to see me because you hurt your wrist, I order an x-ray, then you come back 2 weeks later saying your wrist still hurts but you didn't go for the x-ray, I can't help you. Or if I prescribe medicine for you and you call back a week later saying you aren't any better but it turns out you never bothered to take the medicine, I can't help you.