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Tue Jan 16, 2018, 06:30 PM

Non-compliance is killing my patients.

I had a patient come in today with severe gangrene on his right hand, secondary to frostbite he suffered on New Year's Day. He's been shuttling back and forth between emergency rooms, and resolutely refusing to comply with their recommended treatment plans. He was referred to ortho surgery for amputation of the affected fingers, and he didn't follow-up. He went to a hospital across town. Same thing: he refused to follow their recommended treatment plan. Finally, he came in to the clinic today with his hand looking like a claw from a monster movie. I read the reports from every medical facility he visited, and implored him to present to the orthopedist for treatment.

He refused.

Just now, I found out that an old patient of mine with a history of colon cancer and a colectomy has been diagnosed with a recurrence of the cancer. It's pretty bad and he's passing whole blood all the time. His care coordinator confirms that the hospital referred him to oncology, and that he refuses to go. He's walking around in an uncommunicative daze. He wouldn't even talk to me; he just wandered out of the clinic even after I begged him to stay.

Today is not going well...

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Response to Aristus (Original post)

Tue Jan 16, 2018, 06:37 PM

1. Sorry. You have my admiration.

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Response to Aristus (Original post)

Tue Jan 16, 2018, 06:39 PM

2. So Sorry For Your Frustration With Patients Who Refuse to Live in Reality-Even At Their Peril

Denial is a destructive pathology, as you've shared in your post. Unfortunately, there is no known treatment.

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Response to Aristus (Original post)

Tue Jan 16, 2018, 07:06 PM

3. Omigod, my dear Aristus, how horrible.

Why do they even bother to come in when they know they're going to refuse?

I am so very sorry. They cannot be reached. My heart goes out to you...

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Response to CaliforniaPeggy (Reply #3)

Tue Jan 16, 2018, 07:12 PM

4. I don't know...

I wish someone could tell me...

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Response to Aristus (Reply #4)

Tue Jan 16, 2018, 08:15 PM

6. The answer is rather simple, people give up hope.

Sometimes it is what "we" do. I have had occasions to give up, but a day goes by, and a gleam of sunshine gives me some hope. So, "we" try to start following the doctor's orders again.

When the pain increases, you go back to the doctor, even if you haven't followed the orders. You say why? Because after a while, you would rather not follow the orders..well??? maybe too much trouble. Too hard to follow? No one to help you ?? Depression?? Maybe other reasons, maybe one or another. Depends on the person. Usually it has nothing to do with the doctor, it is in the brain of the patient. If it were simple, it would be simple. And it would be simply solved.

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Response to Aristus (Reply #4)

Tue Jan 16, 2018, 11:08 PM

12. Emotions are what drive many of our actions and emotions are not logical...

I'm just spinning a story and I know nothing about either patient but if I had to guess with your patient with Gangrene, likely mental illness plays a role. And with your cancer patient fear and shock may as well. People don't act logically when strong emotions at at the helm. I've battled milder depression and anxiety for a long time and while I've never been to the point where I've made decisions that would have ended my life, I have certainly engaged in a lot of self destructive behaviour, and I'm a smart cookie. You may see the physical damage, but the emotional state of the person is sadly invisible but a far better indicator of what action they will actually take than all the visible signs in the world.

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Response to Locut0s (Reply #12)

Wed Jan 17, 2018, 01:52 AM

13. I think the guy with gangrene is in denial

It happened too fast. New Year's was only 2 weeks ago. That's very shocking to go from frostbite to gangrene.

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Response to LeftInTX (Reply #13)

Wed Jan 17, 2018, 04:35 AM

15. He could be but frostbite is not a mild condition...

Usually you are in shocked denial when something totally unexpected hits you. If you have frost bite serious enough to turn into gangrene that turns your hand into a black claw... Well that frostbite itself would have been so serious that you probably wouldn't be as shocked that that might happen. Remember frostbite that bad means the tissue has basically died. His hand would have been a lifeless stump. Though I agree it might still be just denial.

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Response to Aristus (Original post)

Tue Jan 16, 2018, 07:18 PM

5. I'm sorry Aristus

Humans are frustrating, but you're one of the good guys. Remember your successes.

I'm not religious but I see a lot of wisdom in the serenity prayer:

God, grant me the serenity to accept the things I cannot change,
the courage to change the things I can,
and the wisdom to know the difference.

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Response to Aristus (Original post)

Tue Jan 16, 2018, 08:47 PM

7. Do they have insurance?

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Response to Aristus (Original post)

Tue Jan 16, 2018, 09:02 PM

8. I hope the balance of the day went better, Aristus

Donít judge each day by the harvest you reap but by the seeds that you plant.
Robert Louis Stevenson

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Response to Aristus (Original post)

Tue Jan 16, 2018, 09:14 PM

9. If I were in his position, I would still be in shock from the horror of the diagnosis and possibly

be in denial -- I'd probably be doing what he's doing until I reached a way to accept the diagnosis, then proceed.

Awful situation! Thank you for your efforts to help him...

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Response to Aristus (Original post)

Tue Jan 16, 2018, 10:04 PM

10. That sucks

I hope you can find some solace knowing the help you are providing to so many others. I appreciate your posts.

Peace

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Response to Aristus (Original post)

Tue Jan 16, 2018, 10:15 PM

11. I've found non-compliance

is mainly due to denial. I've had patients close to death that are in complete denial about their health. It's very sad but more common than we'd like to believe.

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Response to Aristus (Original post)

Wed Jan 17, 2018, 02:00 AM

14. My husband has an uncle who got a rose thorn caught in his finger

Him and his wife were complaining that it was turning out to be a bigger deal than what they thought. It was mostly small talk, we all agreed that getting a thorn caught could lead to infection or having to have surgery to remove the thorn...It was a typical, matter of fact type conversation.

She died a few years ago.

At her funeral, I noticed one of his fingers was missing.

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Response to Aristus (Original post)

Wed Jan 17, 2018, 09:02 AM

16. We all have the right...

 



...to live or die with our beliefs. It is our 'freedom of choice' as humans and it pains me daily to see people dying for "beliefs" that I cannot support. But since it is THEIR life and since I believe in democracy and the after-life, I'm content to let them learn things on their own.

I'm a college educated high school teacher so you might think I have 'a need' to educate like you have 'a need' to heal. But I don't- after all these years I have concluded that EXPERIENCE is the best teacher. People come to the right answer when they are ready for it and it is only frustrating to try and bring everybody up to my speed.

To be honest, as a student of western culture I'm surprised that we're not all quivering blobs of insecurity considering the massive assault of Corporate Belief Systems that we've endured our entire lives. But......

Live and Learn, eh?!


.

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