You may be familiar with the old expression, “you can
lead a horse to water, but you can’t make them drink”. Well, it is the same concept with patients
that refuse to follow their physician’s instructions. You can provide
directions, explain the importance, but you can’t “make” them follow the
instructions. However, these are people
we are talking about, and in some cases, failure to follow medical advice could
have very serious consequences, so what can you do? As you explain directions to the patient, in
many cases, you can tell by their lack of interest that there is a chance they
will not follow medical advice. It is
frustrating and potentially dangerous for the patient, so is there a simple way
to stress the importance of physician’s orders?
Understanding why the Patient Disregards Doctors Orders
Many patients, often male patients, think of themselves
an invincible. They just don’t think
there will be serious consequences to their actions, or lack thereof. The number one condition patients refuse to
acknowledge, and therefore treat, is high blood pressure. They can’t see it, and many times have no physical discomfort because of it,
so they don’t accept that it exists.
There is a reason hypertension is called the “silent killer”, and you
should point that out to your patient.
There are numerous hands out publications that explain in depth the
repercussions of not treating high blood pressure, make sure you provide them
to your patient. When delivering the
prescription to the patient, or when discharging them, start out by saying, “It’s
very important”, that you take this medication as prescribed. Or, it’s very important that you follow the
doctor's’ orders. It won’t guarantee
they will listen, but the word important sometimes carries value.
Convincing the Patient of the Importance of Following Orders
Be conscience of the method you use to deliver
information and instructions regarding doctor’s orders. Don’t just provide a handout of papers and
quickly toss some verbiage in. If
possible, keep the patient sitting, and then take a seat facing them, making
eye contact. Explain what the doctor’s
orders are, and explain why the doctor is ordering this mediation, or this
particular medical advice. The patient
is much more apt to listen if you provide the information while you still have
them engaged in their office visit, or hospital stay. Provide any pertinent information, however,
make sure the patient understands the directions, and ask them if they have any
questions or concerns with following the medical advice. No, you can’t follow them home and make sure
they follow orders; however, you can express the seriousness of adhering to
medical advice and recommendations.
Responding when the Patient did not follow Directions
In the event a patient returns for a visit, and their
complaints center around the fact that physician’s orders were not followed, it
can make for a stressful visit for the patient.
Regardless of the fact that the patient did not follow medical advice,
they are in the clinic for medical assistance.
Try to look at it from the patient’s perspective, they are most likely
ashamed, and embarrassed for not following orders. Their medical state may be less than ideal,
and the patient is undoubtedly angry at themselves, even if they can’t come to
terms and admit it. The ideal way to
handle a situation such as this is to avoid the subject of the patient’s lack
of cooperation in following instructions.
The patient before you is in need of assistance, and their previous
decision to ignore instructions is irrelevant at this point. Concentrate on the here and now. Treat the patient with the same respect and
courtesy as usual, and don’t dwell on their inability to follow previous
medical advice, they may have learned a valuable lesson for the future.
Support Groups & Education
When a patient is diagnosed with a condition they are
not familiar with, they have a lot of information to process at once. Diabetes and hypertension are two conditions
that most often are ignored. There are
educational classes and support groups at most hospitals that are designed to
instruct the patient on proper care, diet, and anything associated with their
medical condition. Suggest, and
encourage the patient to attend any class or seminars that will benefit
them. Classes of this nature are
designed to offer an abundance of information in a controlled surrounding that
will be of great benefit to the patient.
Engage the Patient
When discussing doctor’s instructions and advice, it
may be overwhelming for the patient and any family members that are
present. It takes time to process
important information, and it may be more than a person can take it at one
visit. It may be a better solution to
ask the patient if they would prefer to schedule a follow up visit to discuss
the protocol further. Also, be sure to
engage the patient in the discussion, ask them if they understand, and if they
have any questions. The more they will
discuss with you, the more they will comprehend.
While it’s true, you cannot force a patient to follow
medical advice, you can explain the reasons and importance of following their
doctor’s orders. In every situation, an
educated and informed patient is much more likely to do what is necessary to
treat their medical condition. In the
event that a patient cannot purchase recommended medications for financial
reasons, suggest patient assist programs offered by many pharmaceutical
companies. A well-informed patient is
more likely to treat their medical condition as prescribed by their medical
team. You, as the nurse, in many cases
are the liaison between the patient and their physician, and it's imperative to
convey to the patient, what needs to be done to correct, or properly control
their medical needs. It is also very
important to alert the attending physician to the patient’s objections to
recommended care or medications, and to any reluctance the patient displays. In many cases the physician can make adjustments
or prescribe a better tolerated medication that will make the patient more
comfortable and willing to comply with instructions.
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