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Grumpy patients? What's next?

Jul 07, 2010

I started my day with a grump. Have you ever had a patient come in, arms crossed and mad as can be that anyone would say he had diabetes? I had an inkling that I might have a challenging patient when he was yelling at his wife before he even got into the education room!

When he and his wife came in, they both plopped down on the chairs and exclaimed, “He does not have diabetes!” He wasn’t sure if the test was wrong, or just the fact that the criteria for diagnosis was wrong, be HE DID NOT HAVE DIABETES!

I generally enjoy my work and my patients, but occasionally, one just gets under my skin. I try to stay pleasant, but it is a challenge indeed. I looked at this couple, angry and upset, and I tried to figure out what I might say that would help them through denial and frustration. Starting with dietary restriction did not seem like a good beginning.

So I went back to my basic knowledge of stages of behavior change.

Wikipedia defines precontemplation as "people are not intending to take action in the foreseeable future, usually measured as the next 6 months." That sure seemed to fit. So I thought, perhaps I’ll just see if I can help him relax. So we chatted about frustrations with medicine, the ever changing world, and basically, I just listened. We started to laugh about life, and I can’t even remember what we laughed about. His wife started to say she liked this visit. The patient asked me if I would like to check his blood sugar (we hadn’t even brought that up!). He asked for his blood pressure to be checked. We talked of healthy eating and laughed some more about how challenging food plans can be. We talked of exercise and how much he thought he was already doing (it appeared to be minimal tasks of daily living…but that will wait for another day). When he left the office, he agreed to keep track of his food, watch the quantity a bit, and keep moving. In addition, he is willing to return next week.

So, back to behavior change. Perhaps he has shifted categories: Preparation is "people are intending to take action in the immediate future, usually measured as the next month” in Wikipedia. Now wouldn’t that be great!

Share your stories about challenging patients, and how much “patience” it sometimes takes just to make them smile and return, no longer as angry and perhaps even ready to make a change or two.

3 comments

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  1. Aug 26, 2010

    I have found that Motivational Interviewing helps with the patient who is "challenging", "resistant" or "non-compliant". I began utilizing Motivational Interviewing when I held a position that provided diabetes education telephonically, which can be more challenging in getting some patients involved in the conversation. This method of promoting behavior change can be very effective in reaching the patient who does not seem to be interested in interacting with the provider. There are some helpful resources on Motivational Interviewing available and you can find more informational reading and webinars that can help you learn about the techniques utilized. I am the author of "Motivational Interviewing in Nursing Practice: Empowering the Patient" and this book demonstrates how it can be used in different areas of health care and when faced with different challenges, including the "resistant" patient.
  2. Jul 21, 2010

    I also like my job however lately I have had a young gentleman in his 30's come in and state he is xxxxxxx off that he has diabetes. I've learned when someone verbalizes their anger as he did, usually there is a reason. I asked what his biggest concern was and he talked for half an hour about his father who is blind and recently had an amputation related to diabetes. After listening and providing reassurance he agreed to test his blood glucose pre and post any meal of his choice. After one week he called to schedule an appointment. He has no completed the dsme classes and is doing quite well. His initial A1C was 10.9 and after 1 month is 8.5. I agree some patients need time and someone to listen to them and clarify some of the myths or just provide reassurance.
  3. Jul 07, 2010

    One of my most challenging patient was sent to me by his pcp with an A1C greater than 16 who is non-compliant with her poc, I was told by provider that he comes to visit for his appointments however does not adhere to or follow anything she saws however the fact that he keeps is appointments was a positive sign that he was indeed open to some kind of help in lowering his A1C, after meeting with him he voiced his mistrust in western medicine his theory is that there is a cure for diabetes however the pharmaceutical companies and others will not reveal this cure due to hs belief that there would be too much of a financial loss for them. He was reluctant to use Insulin as he stated he wanted to lower is A1C the natural way. We were able through partneship with his pcp myself and Nutritionist who he saw once and refused to see again to get him to titrate is Lantus his A1C came down to 10 and thats as far as we can get him to go, I will not give up however I have tried everything in the book to no avail.

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