What You Should Do When a Patient Doesn’t Comply

Chances are, if you work in health care, you have found yourself in some variation of the following scenario:

Nurse: Hello, Mr. X. How are you feeling today?

Patient: Not good! Even worse than when I saw you last week!

Nurse: Oh, goodness. The new medication doesn’t seem to be helping?

Patient: Oh, I decided not to take that. I didn’t like what the internet said about it!

Whether it is about medications, diet, exercise or other forms of treatment, non-compliant patients can be both frustrating and disheartening.

What can we, as nurses and healthcare professionals, do when a patient does not comply?

Initially, we need to find out why the patient is against the treatment. These reasons could range from a lack of knowledge on the need for a proper diet to something more serious. I once had a patient who was non-compliant with pain medication, even though she was in terrible pain. Her mother had been allergic to the prescribed pain medication and the patient was terrified to take it but had never mentioned it to her provider. Once I found this out, we were able to get her pain controlled within a few hours.

Often, the reason a patient does not comply is that they just do not want to. Then, we have to make sure we provide as much education as possible on the given topic in a way that the patient understands. They need to know why this particular treatment is important for them.

Ultimately, we have to protect patient rights and advocate for their autonomy. I had a patient who came to my medical respite center to receive IV antibiotics and wound care on his left foot. Our center served patients who were experiencing homelessness and gave them a place to receive acute medical care in a safe environment. About a week after admission, this patient learned that his girlfriend was going to leave town without him. He asked to be discharged, even though he had 40 days of antibiotics left and his wound was not healed. The providers said he could not leave; he would be putting himself at too much risk.

I spent an hour discussing everything that could possibly happen, medically, if he left against medical advice (AMA). He would not finish the IV antibiotics as we would have to pull his central IV line before he left. His wound could get worse. My patient insisted on going to find his girlfriend. After he had all the possible information I could give, I advocated the medical director to prescribe oral antibiotics and an order for me to pull his line. The patient left very happy and grateful. He was still happy with how I had treated him when he returned to us three months later after having his left foot amputated.

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