I am currently on my rural prac and am therefore fortunate enough to see a number of different conditions. Last week I was asked to assess and treat a patient with an acute exacerbation of COPD. The patient was middle aged and therefore I expected someone that would be very compliant to treatment as they are clearly unwell at such a young age. However after reading through the notes I realised that the patient was still smoking 50 cigarettes per day, not taking any medication and not attending any rehabilitation classes. She was also obese and suffering from type 2 diabetes.
When I assessed the patient I was confronted with someone who had obviously had negative experiences with medical professionals in the past as she was not keen for my help at all. I explained the importance of a thorough assessment and how physiotherapy advice could help her situation so she reluctantly allowed me to continue. After assessing her I realised she had impaired airway clearance, decreased exercise tolerance, airflow limitation and decreased gas exchange. As she was still able to mobilise freely I provided her with an ambulation program, demonstrated the ACBT and suggested she sat out of bed as much as possible. Her response was that she was already walking outside to smoke regularly so didn't need to do any of the other stuff and wouldn't do any of the other stuff. She also told me she would not take any of the medication the doctors had prescribed and that she was not interested in attending pulmonary rehab classes and would smoke till the day she died.
I decided to leave the patient for a day and follow her up the next day as I thought she may have been suffering from nicotine withdrawal and she was still ambulating, all be it for negative reasons. However, on return she was even more adamant that she would not comply with any suggested medical or physio treatment.
This frustrated me as she came to hospital expecting to 'get fixed' but would not allow me to do my job in helping her. I felt as though she was taking up room that someone else would benefit more from occupying. On top of this she was also irritating the other patients in her room and affecting their recovery.
I just wonder if anyone else has any thoughts on these types of patients or any suggestions in gaining their compliance.
In the end their was nothing I could do as she refused treatment but I think I will approach similar patients with much more preparation in future and think of more enticing ways to sell physiotherapy treatment.
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I have had similar patients and I find it aggravating that there seems to be no solution to a problem such as this and that it feels as though time is wasted trying to convince someone to attend physio when you already know the outcome. I think that it is hard for a lot of us to accept that some people just wont accept the help because that was the reason we entered this profession to start with - to help people.I think at the end of the day, all you can do is give all the information to can as to the benefits of physio but if treatment is denied it is ultimately the patients decision.
I don't know if there is a magical answer!
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