If you hang around in healthcare long enough, eventually your paths will cross with a non-compliant patient, which for the record is not the same as non-adherence patient. A non-compliant patient is defined as; “patient behaviors” that frequently interferes with the effectiveness of treatment for a variety of medical conditions and can have serious medical consequences. While non-adherence is, simply doing medial tasks incorrectly and overtime may jeopardize a patient's outcome.
Defining Patient Non-Compliance
In defining a patient’s non-compliant behavior the four criteria have been suggested: 1) Is the patient’s medical problem potentially serious or does it pose significant risk to life; 2) Has at least one treatment plan, been correctly followed. 3) Has the patient had easy access to the treatment or treatments; and 4) Does the patient deviate, significantly from most patients, with regard to medical advice, treatment, or follow-up care (Kliensinger, Fall 2003, p. 18).
Difficulty with Comply
According to Dr. John Steiner, a researcher at Kaiser Permanente, very few patients are fully capable of complying with all their doctors’ requests and or recommendations. To illustrate his point, he constructed a chart for a theoretical 67-year-old patient with diabetes, hypertension and high blood pressure. He then tabulated what it would take to be “adherent” with all medical recommendations: Five prescriptions to be filled monthly, getting to and from the pharmacy, (assuming he even has insurance), diet (cutting down salt and fats), exercise (three or four times per week), make it to doctors’ appointments, blood tests, check blood sugar, and on top of that, remembering to take the pills every morning and then again every evening eve...
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Fred Kleinsinger, M. (Spring 2010). Working with Noncompliant Patients . The Permanente Joural , 14(1): 54–60.
Holm, S. (1993). What is Wrong with Compliance. Journal of Medical Ethics, 19:108-110.
Kliensinger, M. (Fall 2003). In defining NCB, I use the following. The Permanente Journal, Volume & No. 4.
Roslyn Walden, M.-B. (2012, May 17 ). Dismissing a problem patient . Retrieved from Clinical Advisor: http://www.clinicaladvisor.com/dismiss-a-problem-patient-in-10-safe-steps/article/241629/.
The Fiduciary Relationship. (1993). Retrieved from biotech.law.lsu.edu: http://biotech.law.lsu.edu/Books/lbb/x236.htm
Valarie Blake, J. M. (2012, May ). When Is a Patient-Physician Relationship Established? The Virtual Mentor Volume 14, Number 5:, 403-406. Retrieved from The American Medical Association Journal of Ethics.
In her personal essay, Dr. Grant writes that she learned that most cases involving her patients should not be only handled from a doctor’s point of view but also from personal experience that can help her relate to each patient regardless of their background; Dr. Grant was taught this lesson when she came face to face with a unique patient. Throughout her essay, Dr. Grant writes about how she came to contact with a patient she had nicknamed Mr. G. According to Dr. Grant, “Mr. G is the personification of the irate, belligerent patient that you always dread dealing with because he is usually implacable” (181). It is evident that Dr. Grant lets her position as a doctor greatly impact her judgement placed on her patients, this is supported as she nicknamed the current patient Mr.G . To deal with Mr. G, Dr. Grant resorts to using all the skills she
Sarah Cullen and Margaret Klein, “Respect for Patients, Physicians, and the Truth,” in L. Vaughn, Bioethics: 148-55
When we see patients, we must remember that we are not simply treating a disease. We are caring for people with lives, hobbies, jobs, families, and friends, who are likely in a very vulnerable position. We must ensure that we use the status of physicians to benefit patients first and foremost, and do what we promised to when we entered the profession: provide care and improve quality of life, and hopefully leave the world a little better than it was
This requires respect and compassion and prioritizing their comfort and values. I believe that as future physicians, we must be open to the different identities and perspectives of each individual in order to try to understand their beliefs and concerns. This level of empathy allows us to connect with patients on a deeper level and treat them with better quality care. Given this, I was immediately drawn to Georgetown’s Literature and Medicine program. Having taken a similarly named course during my undergraduate career, I recognize how literature, fiction or non-fiction, can create a compelling narrative that draws us into the mind of the writer and the characters. Medically related narratives raise issues that we will be confronted with later on in our careers, such as the respective responsibilities of the patient and physician, the role of medical ethics, and the value of compassion and empathy. This program will help me to become a more reflective and empathetic individual that places the beliefs and comfort of the patient at the forefront of my professional practice, and can competently cater to the needs of a diverse
...r away from the thread of paternalism because the doctor is not inclined or able to take advantage of the patient.
This freedom of choice, Gawande states, ultimately places a burden on either the doctor or the patient as the patient ultimately choose a course of treatment that is ultimately detrimental as in the case of Lazaroff, a patient with only a few weeks to live, but rather insist on “the day he would go back to work.” Despite the terrible risks and the limited potential benefits the neurosurgeon described, Lazaroff continued to opt to surgery and eventually died painfully as a result of surgery. Gawande suggests that Lazaroff “chose badly because his choice ran against his deepest interests,” which was to live despite his briefing remaining time, ultimately distorting his judgement into choosing a course of treatment that ultimately ended his life in a much more painful manner. Another case of patient decisions that Gawande discusses is Mr. Howe, who aggressively refused to be put on a breathing machine, neglecting the fact that “with antibiotics and some high-tech support...he would recover fully.” As Gawande and K awaited for Mrs. Howe’s decision to save her husband’s life, Mrs. Howe emotionally breaks down
Healthcare providers must make their treatment decisions based on many determining factors, one of which is insurance reimbursement. Providers always consider whether or not the organization will be paid by the patients and/or insurance companies when providing care. Another important factor which affects the healthcare provider’s ability to provide the appropriate care is whether or not the patient has been truthful, if they have had access to health, and are willing to take the necessary steps to maintain their health.
In conclusion, every patient is worried about their rights to care but not so much are focused on the rights of the physicians providing the care. It is hard to establish a respectable practice if you are required to perform care for instances in which you object or do not want to be a part of. This detracts from the ethical background of practice and procedure every physician should hold to the highest standard.
In the medical field, there are many ethical dilemmas that a person could face. One of the major dilemmas in the medical field comes from being a doctor. While attending to a patient/ client the doctor may not know the best treatment or course of action to take because of the many options there could be. The values and beliefs of a doctor can’t interfere with the treatment of a patient/client. Their job is to be honest, benevolent, respectful, and to maintain confidentiality of the patient/client.
Most doctors agree that the dehumanization in the clinical setting can lead to the loss of a patient because of the lack of respect they are given. That is a great incentive for doctors to try to get to know their patients and make them feel as comfortable as possible. When a patient attends a teaching hospital where aspiring doctors exam patients in groups, there is no real reward for them learning personal information about the patient. They will move on to start their own practice and probably never see the patient again. However, just because the patients are at a teaching hospital does not make them any less important, so how can medical school programs promote patient-physician relationships when the physician has nothing to gain?
Each day we are faced with making decisions regarding the plan of care and discharge of a patient based on the number of days an insurance company allows to treat the patient. Most times the days allowed are less than what is required to assist the patient back to their prior level of function and ability to safely return home. This causes an internal struggle for the provider and can lead to easily accepting what the insurance company allows even though it is not always best for the patient. Typically, we follow the rule of always doing what is right, which could mean that we keep the patient on the unit longer than the insurance will provide payment.
In the face of the threat of euthanasia, does the patient have the right to the final word? What are his rights in the area of medical care? This essay will explore this question, and provide case histories to exemplify these rights in action.
... to less healthy patients through negative cues. All could increase patients' dissatisfaction (Braunsberger and Gates, 2002).
patient history is neglected resulting to a serious health crisis or ever death and lawsuits.
1. Advice patients of their rights to make informed medical choices, ask if the patient has an advance directive.