Ah, the good old days. How many of us watch a classic movie or TV show wistfully as the screen portrays the “And how’s Auntie May doing?” banter between doctor and patient. There’s just no time for all of that anymore, is there?
Trust is one of the most important instruments a medical professional keeps in his/her metaphorical medical kit. So, why does it seem that more patients aren’t following their doctor’s orders?
The doctor/patient relationship should be unquestionable. The truth is most patients do trust doctors. When a patient returns having done little or nothing at all that has been recommended, however, it’s natural for a doctor to be frustrated or concerned.
So, it helps to understand why the patient appears to be apathetic – the problem often lies in the personality of the patient. Here are a few issues to consider.
A doctor has seen it all and is well versed in treating all types of ailments. That can mean little to a patient. Don’t underestimate how simple yet awkward ailments can cause embarrassment for individuals of all ages and backgrounds. Remind them they are not alone. It may even be a good idea to have a nurse or another doctor (for example, a female doctor) speak with the patient.
With privacy an issue in general, some people are concerned about whether their physician will share their medical information with other parties. This may lead them to lie, downplay their issue to the doctor or simply not return. Doctors can handle this upfront by pointing out they maintain the very high professional standards expected of them. Experience should tell them when a person may be worried: for example, if he/she is HIV-positive.
This is a difficult one. A doctor finds that the patient seems genuinely concerned and motivated, yet doesn’t take his/her advice/the medication prescribed/the ailment seriously enough. Is it the patient, or is it someone else? Every family has one – a sceptic, the faddist, the influencer that will weigh in on the treatment of a family member and even sabotage it. Once it’s established that this is happening, a plan can be formalized.
Much has been studied and written about denial of illness. Although particularly prevalent in mental health, it can appear as a form of coping mechanism with a physical ailment. This may require professional mental health therapy along with ongoing treatment.
This can take form in a number of ways – an illness may leave a patient vulnerable at home, at work or with acquaintances, so it isn’t dealt with properly. Perhaps the particular diagnosis/treatment leaves an individual feeling vulnerable because of certain beliefs. Talking to the patient then working out the next steps (which may include psychological treatment) is the best way forward.
This can include fear of death, fear of pain, or fear of being incapacitated. A person with an illness phobia is experiencing a mental illness similar to an obsessive/compulsive disorder. These patients are often obvious to a doctor and the appropriate treatment – including a visit to a psychological specialist – can often make a difference.
It happens. Ask questions, address the issue and work forward with the patient.
As well as the initial illness, this often needs to be treated as a mental health issue. It can be a form of “suicide by neglect”; therefore, a series of ethical, legal and moral issues cloud the treatment of this patient.
What are your experiences?
This is an issue that will not go away. If the medical community shares past experiences, successes and failures, it may help someone in the future. Every insight helps.