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How to Work with Patients Who Refuse to Follow Physician Instructions



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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