Non-Compliant??? - DSN problem

[lucylocket61]

I am feeling a bit scared. I am no good at face-to-face confrontations

My DSN insists I take statins and bp medicine. Even thought my cholesterol and bp are well under the safe levels. And even though I have told her I am unwilling to have them.

I do NOT want them. I WILL NOT swallow them. But she wont listen to me. She insists that a 3 point medication plan is essential, standard practice and preventative and I MUST have them.

Or I will be considered "Non-Compliant" and it will be put on my records and could affect my future treatment options.

I was too angry and gutted to ask what, exactly, she meant. But I feel bullied. She already talks to me as if I was an idiot, in a sing-song childish voice.

I am now scared she wont treat me if I get ill, or get complications. She has already said she wont give me a cholesterol test until I agree to take the statins and take them for 6 weeks.

I am afraid of being left with no medical back-up if I refuse to take the tablets. I have already complained in writing once to this surgery, and got referred to her instead of the standard nurses. My doctor says my treatment is not her remit and I must see the DSN.

I feel trapped. I cry when I get upset, and I wasnt going to let this woman see me upset. She is the same one who says I will end up on insulin and its my fault for being overweight (even though she is bigger than me) and that I MUST have lots of carbs to give me energy. Flippin' heck, I have enough stored energy to power Glasgow if I could access it!!!!

I dont know how I would get private treatment or private cholesterol testing, even if I could afford it. I need to know my ratios as well as the total cholesterol.

Sorry to go on and on.........I dont know what to do. There is no-one else in the practice to go to - and no other practice to use.

 

[))Denise((]

So what would happen if your blood pressure went too low? You could ask her this, as you don't want to be fainting all the time. Not all diabetics have high blood pressure - I know I don't. Anyway having my blood pressure done at the surgery tends to put it up a bit but not enough to be prescribed medication.

I have statins, but I am terrible at taking them (and I'm not sure they are doing me any good). You could get them put on your prescription and then not take them (a waste I know) and then have the cholesterol test after the six weeks of pretending to take them.

There are some HCP that you just don't warm to. I think it is a bit remis of the GP to leave all the decisions to her. Even if she is the 'diabetes specialist' you could still talk to the doctor about the statins and BP medication.

You are trying your best at low carbing Lucy and from what others have said then this should have lowered your cholesterol anyway. Perhaps you could ask for another cholesterol test before you accept the statins.

 

[xyzzy]

Well as an example a Cholesterol Test will cost you £69 from here http://www.medichecks.com/index.cfm?s=2&d=21&test=CHO&name=Cholesterol but that's not ideal is it?

Lucy this is going to be a difficult one to answer as the way you deal with it must be your decision. However to get you going...

Maybe ask for a meeting with the practice manager and point out the following. Tell them you are shocked by the DSN's blatant attempt to blackmail you into obtaining consent and you will take this further unless the harrassment stops. Why not ask your husband to go with you or you could contact these people http://www.pals.nhs.uk/

In the meantime here are the GMC rules your GP should be following. Threaten the GP that under 27 THEY are responsible for the action of the DSN not the DSN so it's in THEIR interest to get this resolved.

http://www.gmc-uk.org/static/documents/content/Consent_0510.pdf

26. If you are the doctor undertaking an investigation or providing treatment, it is your responsibility to discuss it with the patient. If this is not practical, you can delegate the responsibility to someone else, provided you make sure that the person you delegate to:

a. is suitably trained and qualified
b. has sufficient knowledge of the proposed investigation or treatment, and understands the risks involved
c. understands, and agrees to act in accordance with, the guidance in this booklet.

27. If you delegate, you are still responsible for making sure that the patient has been given enough time and information to make an informed decision, and has given their consent, before you start any investigation or treatment.

43. You must respect a patient’s decision to refuse an investigation or treatment, even if you think their decision is wrong or irrational.10 You should explain your concerns clearly to the patient and outline the possible consequences of their decision. You must not, however, put pressure on a patient to accept your advice. If you are unsure about the patient’s capacity to make a decision, you must follow the guidance in Part 3.

 

[lucylocket61]

Very useful, thanks both.

I didnt realise i had rights about this.

 

[Paul1976]

Very useful, thanks both.

I didnt realise i had rights about this.

You absolutely DO!! This is unnacceptable behaviour on her part.

 

[didie]

You are caught between a rock and a hard place Lucy

Is there not a doctor in your practice with an interest in diabetes?

As xyzzy says, maybe a meeting with the Practice Manager is the way to go armed with some advice from PALS.

http://www.pals.nhs.uk/cmsContentView.aspx?ItemID=932

 

[anna29]

Lucy you do have patient charter rights .
This includes the right to say 'NO' and the right to have access to all written information
in your medical files.
The march 2000 data protection act 1998 replaced the access to health records act 1990.
Only 'live' patients can request this!!!
This amused me as to how on earth can we request this when we have gone!!!! :?:
The data protection act entitles you to see all your records.
Could you take someone 'along' with you for moral support ?
This may give you more confidence and you will also have a witness as to how
she is with you.
Do let us know how you get on.
Will be thinking about you, as to be treated like this is plain wrong... :thumbdown:
No wonder you feel more upset and fearful when being treated in this manner.
Anna.

 

[librarising]

lucylocket61 wrote
she wont listen to me. She insists that a 3 point medication plan is essential, standard practice and preventative and I MUST have them.

I thought good medicine was about working with the patient. Only on Monday my GP wanted to start me on a statin, following an increase in total cholesterol from 5.0 to 5.4, so I asked for a breakdown of my lipid levels. None was available, so I declined.
I expect that my low-carb diet will have improved (increased) my HDL, and reduced my triglycerides.
Statins are just seen as the wonder drug of the moment. They have benefits. They also (often) have side effects.
My GP deferred to my wishes. Don't know how long before the heat is turned up, though.
I've only ever seen a GP, so haven't endured 'encounters' with a DSN.
Yours sounds like a little Hitler :thumbdown:

I will be considered "Non-Compliant" and it will be put on my records and could affect my future treatment options

Sounds like a threat to me. Very unprofessional. Also sounds as if she'll stop working in the best interests of your health. Is that in her contract ? Perhaps as a nurse she takes a hypocritical oath :crazy:

She has already said she wont give me a cholesterol test until I agree to take the statins and take them for 6 weeks

That for me would be putting the chicken before the egg. Statins are often given to reduce LDL levels. Does she know what these are ?
My point to my GP would be that without a breakdown of lipid levels, which I can go away and analyse, there's no chance I'd take a statin.

My doctor says my treatment is not her remit and I must see the DSN

Your GP may well be right. But your overall health is. Don't know if you can be referred to another DSN. Could turn out to be Genghis Khan to your current 'Hitler' though :crazy:

I dont know what to do

Firstly, I'd recommend The Great Cholesterol Con by Malcolm Kendrick.
I got a copy through my library.
If you want other links about statins, I can PM you some.

Never give in to bullies. Better to stand your ground, and have a cry afterwards, if you have to.
The best way to disagree is with a smile on your face (forced, if necessary.)
And I'm sure you know we'll support you every inch of the way

Geoff

 

[Defren]

My initial thought was take the prescription, get it filled and don't take it. However I do think the advice above is the best way to go. Blackmailing a patient is not the way any health care professional should behave and it seems this DSN needs taking to task.

 

[noblehead]

My DSN insists I take statins and bp medicine. Even thought my cholesterol and bp are well under the safe levels. And even though I have told her I am unwilling to have them.

Lucy they do like bp in diabetics to be below 130/80 as opposed to 140/80 in non diabetics, my own HCP's insist on 130/70 but that isn't the case for everyone. Bp meds like Ramipril are Ace Inhibitors and are given to diabetics in a low dose to protect the the kidneys, so your bp may be fine but they may consider that a low-dose med might be beneficial to you in the long-term.

Statins, well despite you saying your cholesterol levels are fine the World leading experts believe that they offer some protection from Cardiovascular Disease, as diabetics we are twice as likely to die from a heart attack or stroke than someone without diabetes and this is why they are offered, I'm in the same predicament regarding statins but I'm seriously thinking of starting a low-dose when my annual review is up.

Really the choice is yours but don't get upset or feel pressurised to take something you don't want, I'm sure they only have your best interests at heart.

 

[dawnmc]

I wouldn't take statins if you had a gun at my head, evil, evil stuff.
Blimey Lucy horrid situation to be, what a big bully, but really you are going to have to stand your ground, it is so empowering for you if you can. I stood up to a now ex, completely floored him. I bet if you did she wouls start treating you differently.
Good luck

 

[Sanober]

Hi Lucy, I'm in Glasgow. Hellooo.

When I was originally (misdiagnosed) as Type 2 I was called in by my GP (even though I had already seen the local DSN a few times) to discuss statins.

He was very nice about it , and my cholestrol was great and my BP has never been outwith normal levels. Because I didn;t have a clue about statins I went along and basically said he's the expert :lol:

BUT he told me to think about it as a "preventative measure and protection" and it was standard procedure for Type 2 diabetics he gave me leaflets and web addresses to look it up. He also mentioned the possible side affects to me.

He said he wanted me to make an informed choice.

I think I questioned statins here as well and basically I chose to decline the tablets. No one's pestered me to take them.

Shame you've got a nasty DSN though - kindness costs nothing.

 

[librarising]

noblehead wrote
as diabetics we are twice as likely to die from a heart attack or stroke than someone without diabetes

but please remember that 'a diabetic' is shorthand for a grouping of very disparate individuals, all with a varying degree of self-control over their condition.
I exclude myself from the GP-worshipping, NHS diet-following, complication-accepting portion of the diabetic community.
I do not believe the benefit to ME would be as great as to other 'diabetics.'
The more any diabetic incorporates health-promoting habits in their life/diet, the less at risk they become, surely ?

Geoff
promoting fewer lies, **** lies, and statistics

 

[noblehead]

but please remember that 'a diabetic' is shorthand for a grouping of very disparate individuals,

Well you learn something new everyday

Geoff, I've never considered myself desperate but we are all individuals and we need to make an informed choice on what's best for our own health.

 

[alaska]

This wasn't a typo from Geoff. He meant disparate as in sufficiently different to be not comparable.

As in the trials carried out on statins include a varied sample of people with good through to dreadful control and are therefore often not representative of those of us with good diabetes control.

Also, it's worth noting that a number of the studies used have been funded by the drugs companies themselves.

 

[Unbeliever]

You are describing an incresingly common problem Lucy. I have spent several years now battling this sort of thing bu the odds are often stacked against us.
I was given statins on diagnosis and BP medicaion later as a prevenative measure when my drug-induced eye complications began.
I often feel that the Practice DSN could and should be relaced by a robot. They are so limited. Certainly you should vouice your dissent and query what she is doing as you have but as I have said before she may well just be acting in a way agreed with the Gp's and may be a senior and respected member of the staff.
I also belong to apractice where the Gp's don' want to know. It has taken me 3 years to star o get around his problem. That was only possible because i was able to demonstrate to one of the GPs before witnesses that the DSN was ignoring advice and insructions from the Doctors at the Diabetic Annual Reviews. In fact i have recently learned tha receptionists will refer any matters concerning a diabetic to her - even when it is a matter for the doctor not necessarily conneced with diabetes!
Some sort of inernal power sruggle.

I wouldn't worry too much about her refusing to treat you if you are ill or develop complications. If you are ill you MUST see a doctor. Not everything is diabetes -related and the nurse does not have the raining o differeniate. Again complications are none of her business. You wiould probably find that the doctors in your practice would not want o know abut complicaons which they would probably not treat anyhow. and they would leave this to he hospial I is a very rare GP thesed days who takes an interest in anythng they can't claim for. I once had one of those {sigh}
The thing is that on a practical level you have to choose your battles. I am in the same position with regard to having no alternative surgery.
You are probably not going to change the system..You may have to compromise over some things in the short erm or find a non-confrontational way of dealing with hem.
The nurses are very limited. They don't have the training to be otherwise and they are not subsitute doctors although they and sometimes the doctors might like to think so.
Statins as a preventative used to be standard practice and a small amount of BP medication like a low dose of ramippiril probably won't hurt.
he nurses are very often defensive because they know they are inadequately trained in diabetesand cannot cope with what hey perceive as challenges to their authority. You can get a cholesterol es and even an HBA1C and other tests from many High ST chemists if necessary.
Its your choice of course, but I would accept the stains , request the test and hold off taking them until after the es.
You ARE being bullied. Most of us are. Unfortunately the enemy is far more powerful than the individual.
It is often necessary o appear o play the game until you are in a stronger position and have sussed i all out. Things change . Sometimes for the beter.
In the meantinme you have every right to consult a doctor despite the system i your practice. Do it by stealth if necessary. See the doctor about another matter and introduce your concerns about medication. Mentin any side effects wich bother you , give the doctor ime to think and then sugges your medication as a cause.
All this sunbterfuge shouldn't be necessary. But it is. It is all very well to have pronciples but not at the expense of you ==r health.
Look after your health ry to get better results all the time and hen you will be in a stronger position to assert your rights and challenge the Nurse. Best of luck.

 

[Paul_c]

They assume that you will be taking the medication and sticking to the diet/exercise plan they prescribe. The dosage is based upon this assumption. If you don't take the medication, then they assume that the prescribed dose isn't working and will increase the dose... this is why they get upset (quite rightly IMHO) when they discover that you are not following the planned treatment.

this is what my practice has on patient rights and responsibilities:

Patient Rights and Responsibilities

You have a right to expect a high standard of medical care from our practice and we will try at all times to provide the very best care possible within the resources available.

In order to assist us in this we require that you take full responsibility for ensuring that you do not abuse the service. For example, it is your responsibility to ensure that you keep appointments and follow the medical advice given.
Very occasionally a practice/patient relationship breaks down completely. In this situation the patient may choose to register with a different practice. The practice also has the right to remove that patient from their list. This would generally only follow a warning that had failed to remedy the situation and we would normally give the patient a specific reason for the removal.

so basically, being non-compliant can ultimately result in being removed from their list...

PS, I love the weasel words they have there: "we will try at all times to provide the very best care possible within the resources available." which basically means they will pick the cheapest option going and only go to more expensive means if they fail.

 

[ladybird64]

I am feeling a bit scared. I am no good at face-to-face confrontations

My DSN insists I take statins and bp medicine. Even thought my cholesterol and bp are well under the safe levels. And even though I have told her I am unwilling to have them.

I do NOT want them. I WILL NOT swallow them. But she wont listen to me. She insists that a 3 point medication plan is essential, standard practice and preventative and I MUST have them.

Or I will be considered "Non-Compliant" and it will be put on my records and could affect my future treatment options.

I was too angry and gutted to ask what, exactly, she meant. But I feel bullied. She already talks to me as if I was an idiot, in a sing-song childish voice.

I am now scared she wont treat me if I get ill, or get complications. She has already said she wont give me a cholesterol test until I agree to take the statins and take them for 6 weeks.

I am afraid of being left with no medical back-up if I refuse to take the tablets. I have already complained in writing once to this surgery, and got referred to her instead of the standard nurses. My doctor says my treatment is not her remit and I must see the DSN.

I feel trapped. I cry when I get upset, and I wasnt going to let this woman see me upset. She is the same one who says I will end up on insulin and its my fault for being overweight (even though she is bigger than me) and that I MUST have lots of carbs to give me energy. Flippin' heck, I have enough stored energy to power Glasgow if I could access it!!!!

I dont know how I would get private treatment or private cholesterol testing, even if I could afford it. I need to know my ratios as well as the total cholesterol.

Sorry to go on and on.........I dont know what to do. There is no-one else in the practice to go to - and no other practice to use.

Hi Lucy

You have been given the details of the PALS webite from Zizz, they are good but can I offer a few suggestions?

Try and decided what it is that you want before contacting PALS. Do you want to start a formal complaints process against the GP, if so, what exactly is it that you wish to complain about and what would you want as an outcome? No, I'm not trying to put you off but this is the kind of information they will require before they can take the complaint any further.

It might be the fact that you feel intimidated, or that your GP is trying to bully you into treatment that you do not wish to undertake. If you feel that the relationship between you and your GP is really bad, then maybe consider advocacy..PALS should be able to help with this.

I have recently been through a formal complaints process against against an HCP on behalf of my mother, in this case PALS didn't want to touch it with a bargepole and referred me straight to the Complaints Manager of the Health Care trust..they did give me advice before they referred though.

Good luck and don't be scared to take action for yourself x

PS. Have just seen that Paul C has added a post..I have to say that I agree with him on this. I refused medical intervention for my diabetes but would not have just accepted a script and kept quiet about it. Refusing treatment is everyone's right but to make out that the medication is being taken when it's not is not a bright idea.

 

[shop]

Hi Lucy,

I agree with all of the replies. You do have rights and if there is no need for the medication, then you should most certainly not be bullied into taking it!!

I few yrs back I was called into my GP and told as I was Diabetic I was to take Statins and Asprin. ( Not, I hasten to add because I needed them. ) When I got home I investiated both and there was alot of information in the media about the problems with Asprin and Statins. There were more reasons not to take them!! I simply didnt take them.

The next time I saw my consultant I raised this with him and he agreed that I had no significant risk for either cholesterol or Heart disease at that time. ( He said It would be reviewed as I got older )

I have a low cholesterol and would manage it by diet anyway.

He was quite happy for me to not take them and put it in writing to me and my GP as he always does after every consultation.

I hope that you get treated fairly and in a professional way.

This treatment you have been subjected to is unacceptable.

Lucy. xxx

 

[lucylocket61]

WOW!! just been out to cry over my friend whose husband is Type1 and whose son has just been diagnosed Type1 too (he is 17 years old) and is going through similar issues of bullying and non-helpful stress from the surgery.

Thanks for all the replies.

I have my last test results now. As of 27th Feb 2012 (before I started low-carbing and stuff) My BP is 120/70 and my cholesterol is:

Total: 4.5
HDL: 1.2
HDL ratio: 3.8

I am not totally against meds. But I am against bullying and not being given a choice. It seems I have to find a way around this. I dont want to start formal complaints procedures. I will have to stand up to her, nicely, I think. I had a practise at being assertive today getting actual figures for my bp and cholesterol from the surgery instead of just being told everything is fine and not to worry, my health is their problem, so I dont have to worry about it.