Improving Outcomes for the Non-Compliant Patient/Resident/Person

When you find yourself in a conflict with the patient, one of the best techniques you can use is to separate the person from the problem. How do we do this? In these situations, it becomes a conflict between “my way” and “your way”. And we just keep battling until either one of us wins or we both get more frustrated. This doesn’t do the patient any good and it wastes our time. Let me give you an example. The patient comes in and hasn’t been taking their medication. Usually we would say, “Why haven’t you been taking your medication?” And what we really mean is, “Why are you being a problem?” This approach rarely works.

So, instead you might want to say to the patient, “How are you and I going to solve the problem of the medicine getting into you?” The problem becomes the third person in the room. You have separated the person from the problem. Now the person isn’t the problem, the problem is the problem. This takes the pressure off the situation and the two of you can begin to brainstorm to figure out a workable solution.

One quick note before you start brainstorming, make sure you understand what is the real issue. Are they not taking their medicine is because they can’t afford them? Are they not taking their medicine because they don’t like the way it makes them feel? Or are they not able to cut the pill in half or open the medicine bottle? These are just a few examples of the many reasons people might not be taking their medications. Figure out what the real issue is and you’ll be able to solve the problem together.

Have a kind and respectful day.

When the patient or family member is a bully?

I don’t have to tell you when a patient or their family member is bullying, you know. Nobody says the word “bully”, but that is what is going on. People bully the doctor to get what they want because they are desperate, afraid, guilty or any number of emotions. They want you to save their loved one so they can resolve their issues with the person. Maybe they haven’t been a good daughter or haven’t said sorry, so they try to make you do something you can’t do. Save their loved one. So what can be done?

The first thing to know is that you have something called professional integrity. And this is not a small thing. It is one of the four state and federal interests. The four interests of the government are:
1. To protect people from death
2. To protect people from suicide
3. To protect vulnerable populations
4. To protect the integrity of medicine

Of all the things the government could have wanted to protect, they chose you, the healthcare professional. They understand that what you do is special and you need to be able to exercise your medical integrity and not have to give in to patients demanding treatments that aren’t good for them and will not work. Even the AMA supports you in this. They state that you don’t have to give a patient a particular treatment just because they demand it. It still has to be “good medicine.”

So what can you do when you find yourself up against a bully? Stop the bullying the minute it starts. Every time you give in to their demands, they get more powerful and they think they can get away with it. You need to be firm and state, “I won’t give your loved ones treatments that will not work. I will not subject them to the toxic side effects without the chance of any benefit.” And you have to say it with courage and strength. You don’t have to be hostile, just confident.

The next thing you can do is to make sure you offer something else instead. Most of the time when we say no to a patient, we don’t give them another choice, we just say no. When you are going to say no, then be sure you have a number of other things you are going to offer. Even if it is as simple as improving their pain management, putting them on hospice, getting the social worker to contact their religious leader or … Every time you give up your authority, you are changing the standard of care. If all of the doctors keep giving it up to bullies, then the standard of care will be that bullies get to dictate medical care. A famous bioethicist, Larry Schneiderman says, “Use it or lose it.” Right now you have the right to say to bad medical treatment demands, but you must exercise that right in order to keep it.

Have a kind and respectful day.