It's going to be a bad day: How to care for a non-compliant patient

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As NPs, we cannot be paternalistic to our patients; rather, offer them the best choices based on knowledge, compassion and research.
As NPs, we cannot be paternalistic to our patients; rather, offer them the best choices based on knowledge, compassion and research.

I'm usually in a pretty good mood; I try my best to not let things bother me. However, yesterday afternoon, my medical assistant was bringing my first patient of the afternoon to be examined, and I overheard the patient say, “Sean's going to be mad at me because my A1C is going to be high.” Well, great, that's a pretty good sign I'm walking into a non-complaint out-of-control comorbid mess. It does not bode well for the rest of the day.

The question that comes to mind is, how do we encourage our patients to follow these perfectly crafted plans that optimize multimodal therapy? I'm sure no one else has the problem of patients asking me to solve their personal problems and lives of chaos. There are days when I feel like I'm a circus performer just trying to keep the plates spinning.

That patient walked into the office with out of control blood pressure and extremely high sugars. In my experiences, when you confront a patient with an appropriate, guideline-based, well thought out plan that they can afford and understand, the patient tells you that they won't follow your plan because a doctor on television said all pharmaceuticals are poison and we consumers are in the pocket of big pharma. In these cases, I often think to myself, "Have you seen my student loan debt?  I am definitely not in any pocket of big pharma."

Of course, that doesn't happen because I've got my life together and I'm a professional and can offer sage advice. At least, that is what I keep telling myself.  It must be working, because patients keep coming back. I've spent a lot of time trying to figure out why. Why do these folks who are otherwise non-compliant continue to return to my office if they are not going to do what I recommend? I don't know if I have the answer, but something a patient said to me recently might be reason.

I was wrapping up a visit with a new patient and she mentioned to me that she's never seen an NP before. In her experience, I was the first provider to really take the time to listen to her concerns. I think for that the most part, we NP's take the time to listen and understand what the patient wants or is thinking. Something I remember from nursing school is that we cannot be paternalistic to our patients; rather, offer them the best choices based on knowledge, compassion and research. It's hard to do sometimes, but maybe if I can get that non-compliant patient in my office often enough, I can hit that right combination of frustration and understanding to eventually make some changes for the better. 

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