Sunday, November 8, 2009

3 greatest challenges

I think one of my greatest challenges is to try to educate and motivate my patients.  Just like medicine can't heal the body, we can only support it while it heals itself.  I can't help a patient heal unless they are willing and motivated to do their part.  The best medications don't work if the patient doesn't take them.  The greatest therapies or surgeries won't work if the patient doesn't want to do them.  Educating a patient on their diagnosis doesn't work if the patient refuses to admit they have a problem. I struggle the most with three issues:  Denial, non compliance (yes I hate that word but can't think of a better one) and lack of personal responsibility. I feel helpless at times to assist a patient in getting healthier, stronger, happier. 

Denial:    The diabetic who refuses to check her blood sugar, who says"But I am really healthy other than my diabetes" and then comes to see me because she is peeing all the time.  She is sure it must be a bladder infection, or a problem with her bladder.  It can't be that her blood sugar is elevated and that makes her kidney's overproduce urine in an attempt to lower her blood sugar. Her normal urine culture and large amounts of sugar in her urine don't convince her.  The normal bladder exam doesn't convince her.   She wants me to fix her problem.  And gets upset when I say the way to fix it is to get her blood sugar under control. The teenager who doesn't want to believe she has placed herself at risk for an STD and doesn't want tested or to use condoms.  And then cries six months later when I say she has Chlamydia or even worse, an STD I have no cure for.
 
Non Compliance:   There is the woman who comes in pregnant and insists she was using birth control but then admits she decided she didn't like having to take a pill every day so she just took them when she had sex and can't figure out why she is pregnant.  "The medicine you gave me just didn't work." is a common complaint...but they didn't take the medicine like they were instructed. You can't take a 10 day antibiotic for one day and expect it to cure your severe bladder infection. If you want to get better, you should probably come to your appointments.  If you aren't getting better, you should probably come to your appointments so we can try a different treatment. 
 
Lack of personal responsibility: The problems they are having are not their fault.  They tell me it is my fault.  Or it is their parents or spouses fault.  I see a huge lack of willingness to accept personal responsibility for their own health.  I see many patients who want an instant fix for their problems.  They don't want to hear that it will take effort.  They want instant cures, something that doesn't inconvenience them, isn't uncomfortable and that requires no effort on their part.  If they didn't take the medicine, it isn't their fault.  If they didn't go get a test done, it was because it wasn't convenient enough.  Or the patient who "has to be seen right away" but can't make any of the appointment times we offer.  Then tell us we are refusing them access to care. 
 
What do I see in patients who do get better?  Honesty, personal responsibility, and persistence. But that is a blog for another time...

5 comments:

Lct4j said...

Ohhh...the patience required to be pleasant when you just want to slap em'upside the head! How do you deflect their criticism of you when it's their own fault?! That would be a constant challenge and morale breaker. Do you see a difference between educated and less educated patients? Higher and lower income patients? Liberally minded or conservatively minded patients (in their political and religious views)? I guess you couldn't publicly answer that question without negative repercussions, but I sure am curious!

Awesome Mom said...

Yeah she is healthy but for how much longer? Diabetes has some really scary complications if it is not taken care of. Just ask the guy in my ward that lost his feet because of it.

Sara Hammond said...

My husband struggles with his Type 1 diabetes in every way you describe here. It doesn't matter how much I yell, scream, cajole, encourage, enable, remind, nag...it is just like you said - It has to come from within them. I often feel exactly the way Ltc4j describes above. If you figure out the magic word to instill some honesty, personal responsibility and persistence in others, I would love to know. My thoughts are with you. Thank you for what you do.

The Lonely Midwife said...

Frustrating! Many just want a Rx or a procedure that will CURE everything, no side effects and no risk. I feel your pain.

pinky said...

Personal responsibility? Now that is a concept? It seems as though as soon as folks step foot in a hospital, they have no personal responsibility.