Non-Compliant??? - DSN problem

[hanadr]

Lucy
although I don't back DUK's dietary advice, they have their uses. The Advocacy service is excellent as is the Careline. If you have trouble with your DSN, contact them. The numbers are on their web site.
DUK's mantra is ; "no decisions about me , without me".
In this country, it takes a court to make you have treatment without your consent.
And What on earth is a 3 point treatment plan anyway? i've never heard of it before.
Hana

 

[viviennem]

I checked - QOF indicator for cholesterol on Diabetic Register is 5 or less. So I'm a bit too high, but Lucy is already on target!

I think she's trying to medicate you unnecessarily, Lucy. Another good phrase!

Viv 8)

 

[lucylocket61]

Thank you for the suggestions and advice.

The problem with me refusing to take the statins is that, if i dont take them, she said she would not give me cholesterol blood tests as there is no point.

I am such a coward

I will ring DUK advocacy on Weds I think for further advice. I didnt know it was possible, so many thanks for that info.

I also want to know if I am worrying unnecessarily about only having a HbA1c through the surgery once a year. I am scared of untold damage or uncontrolled diabetes if they wont test for a year, and dismiss my meter readings as me being over anxious and making a fuss. She tests my urine once a month, but that stops after the next visit, then no test until my annual checkup.

Their view is that it is a very slowly developing disease, so there is no need to hurry or monitor. Any problems will be picked up annually. So my prescribed drug regime of 1 x Metformin is cast in stone for a year before tests and a possible adjustment.

Maybe I am worrying too much about possible damage. I dont know if I am. I think keeping being told I am over-anxious has caused me to doubt myself and my own perceptions.

 

[Unbeliever]

As I said beore Lucy, in your case I ould take the line of least resistance tto begin with.. You are having to deal with the system as it is - not how it ought o be. I wouldn't worry unduly about the HBA1 C . Carry on testing for yourself and recording your results.
if ther is a sudden change and you know why , of course you would record that too. Then if you have any cause for concern after a decent period take your evidence to a doctor.
You do have to allow time for things to settle. Frequent hBA1cs appear desirable bu some HCPs consider only their target figures and overreact.
I don' think 6 months of statins would really do much harm unless you are one of the unfortunates who are very sensitive o them when I would just stop taking them.
So much depends pon how good your nurse is at her ob. As you are low carbing your otal cholesterol may rise without t
he statins.
iThe relally important thing in avoiding complications is to have low, stable bg. So just concentrate on that. if there was any damage before diagnosis it should easily be reversed know that you know about it.

Dealing with the system is the most difficult thing. Yousay you don't like confrontation. I don't believe that confrontation when newly diagnosed is useful in fact just the opposite,
Jus give it a little longer. Maybe go along with what they sugges to begin wtih Carry on with your own controls . When hey see you have made good progress - and me their targets hey will be far more inclined o lisen
As ever the problem is the ne-size-fits -all approach.
Basically you have o do what is necessary to cope with the eisting system in your own way. We have all been there at some stage.
Things do take a while to settle . Give i some time. You have come a long way in a very short time.

 

[librarising]

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.

Lucy, I am returning to your original post, as there are your original concerns.
I cannot agree with unbeliever, who says that "I don' think 6 months of statins would really do much harm."
Physically that MAY be true, although I personally doubt it.
But your post is about your mental suffering through being bullied. You say you feel trapped. To give in to her demands can only reinforce that. To discover the power to say "No ! I'm not doing that, until I'm convinced it's the best thing for me" is empowering, and makes the next time easier.
My cholesterol is over 5 (5.4) and my GP wanted to go down the statin route, which I declined.
Show me my cholesterol profile first !
There wasn't one
I'd never take statins on a total cholesterol level.
If you need hard copy articles about cholesterol ratios, I'm sure we can send you enough links.

She may have a point if she says SHE can't work with you as a non-compliant patient. That doesn't mean the NHS is going to abandon you.
Perhaps ask her, in writing if need be, what her 'threats' about future treatment mean.
See how willing she is to put that down in writing.
Your DSN seems to see only one way for diabetics - downward. Uncontrolled blood sugar, insulin, complications, toe loss etc.
Just because she's in the dark ages, you don't have to be.
That's easy for me to say, but then I was always a rebel :lol:

May the power be with you :thumbup:

Geoff

 

[Unbeliever]

Hi Librarising, My original advice to Lucy was to take the prescription - but not the statins - and leave confrontation until she felt more confident abnd was able to prove successful control of her own condition.

You mention in your post your GP wanting o give you statins which you would not accept. Part of Lucy's problem is that her doctor l
refuses to discuss anything connected with her diabetes and refers her back to the nurse.
I am in the same position so I understand . The difference is that I previously attended another practice where I had a supportive Gp . Unfortunately not the diabetes specialist gP in the Practice but one can't have everything.

It appears that he Nurse was spouting the practice policy at Lucy. She apppears to be one of those who doggedly carries out orders and sees everything in black and white.
I wouldn't take any nonsense fronm the DSN either but to take a pragmatic view , she either does as they say or appeas to do so , for he momen at least , or ins labelled non -compliant.
I was merely advising her to leave the batle until she felt strong enough or had sufficient ammuniion.

She can refuse the statins but her lowcarb diet may raise her total cholesterol figure and she will then face a batle on that score .
in six omonths time she may well be feeling strong enough for that battleas you say. or she can then speak to the doctor who is more likely o pay atenion if she has complied.

It is quite common for Drs to distance themselves from diabetic patients . They prefer to leave the nurse to do tthe dirty work/

I jus tfeel that it is better o fight from a position of strength han to make life more difficult for hereself from the beginning.
it is far easier to persuade drs to appreciate your opinion I always find. It is fighting one's way past the Dragon Guardian Nurse to get o the dr which is the difficulty I am sure Lucy will become rebellious enough in due course to withstand the fiery breath.

 

[noblehead]

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.

Lucy, they have a duty of care to treat you when you are ill/develop complications regardless if you take the statin or not. As for not testing your cholesterol levels in the future they simply cannot do this, take this matter up with your own gp or write a letter of complaint to the practise manager, as someone said earlier the DUK helpline should be able to offer you some advice on how best to approach this.

 

[chris lowe]

Hi Lucy, are you near to a town with a good pharmacy? My local Lloyds offers cholesterol testing - I think it's about £10 and some of the larger supermarkets with a pharmacy will do a test. I'm not sure if it's as thorough a test as you would get at the surgery but would give you an idea.

Hope you can get the nurse sorted out.Even if she won't support you, you can rely on us here. Take care

 

[librarising]

Hi Librarising, My original advice to Lucy was to take the prescription - but not the statins - and leave confrontation until she felt more confident abnd was able to prove successful control of her own condition./quote]

Sorry if I read

"I don' think 6 months of statins would really do much harm unless you are one of the unfortunates who are very sensitive o them when I would just stop taking them."

as suggesting she take the statins. They certainly won't harm her if they're still inside the bottle.

I don't believe that confrontation when newly diagnosed is useful in fact just the opposite

Are you talking from your experience here ? I'd have to disagree. I'd also change 'confrontation' to 'being firm,' e.g. disagreeing with a smile and some indication you're taking your condition seriously.
'Getting off on the right foot' springs to mind.

I don't see your distinction between GP and DSN. Are the latter to be feared and obeyed, while GPs are more capable of having their advice declined ?

Lucy must do whatever she feels 'happiest' doing. Whatever makes her feel less 'trapped' and more empowered.

Sorry, unbeliever, if words (and them being misread ) has got in the way

Geoff

 

[Unbeliever]

IHa ha, No , lucy says she doesn't like confrontation. She obviously feels that disagreeing with this woman would be confrontaional.
i understand what she means.

For myself i do not mind a little confrontation of necesary. in my experience a great deal of confrontation has been necessary to avoid having inappropriate and harmful medication forced upon me and ensuring that I ge the bes possible treatment for my coplications after initial poor and inappropriate treatmen caused me lasting harm.
I have had to learn to be VERY assertive when dealing with HCPs.

The distinction between the gp and the DSN is that i can be assumed that at some stage the GP had a few braincells. the same cannot be said for Some of the people in GPs Practices glorified by the title of DSN which often is a very empty title indeed as there is apparently no common recognised standard for these people.
Some are fortunate to have caring well -informed DNs available . Some are not.
The DN in my practice is by no means a stupid woman but knows very little about diabetes. It has not been necessary for her to know anything. the doctors refuse to discuss anything diabetes related with patients.
I refuse to discuss anything dianbetes related wih the DN. It has taken me a whle to get to this point where i now know which GP will be willing to override the Nurse about medication. I have an extra card in that I can and will appeal to those treating my complications and they will help e as hey havedone in the past.

I feel sorry for anyone in Lucy's position. The Nurse will just be adhering to pactice policy. that is probably why she has the job.
I would never dream of consulting the nurse about anything but i feel very sorry for those who feel they have no option.
No you did not misread my post. I originally advised lucy to take the prescripion but not the pills. this seemed o upse some people and i hought that they may have had a point. i perhaps should not be advising newly diagnosed to disregard the advice given i the Practice.So I changed my advice.
Yes of course Lucy must do what she thinks best.
There is just so much to absorb at first it can all be alittle overwhelming. The authoritarian attitude of some of these nurses is assumed to conceal their ignorance.. Tha is why disagreeing with them is usually not productive . at least to begin with.

She may find she gets on better with the Nurse after a time. I actually get on very well wih mine when i am forced to see her for a blood test. Lucy's Nurse may have had some problems wih non-compliant patients in he past and until she ges o know her better she may tar Lucy wih he same brush.
She may be totally ignorant about cholesterol and sains. Its early days . As Lucy has no alternative to that practice i ust hought it might be better for her o read carefully unil she feels more confident.
I believe she too has the sirit of a rebel- its just waiting to be released.

 

[viviennem]

Does anyone know just what, exactly, being labelled 'non-compliant' means, in its relation to general health care? What is its official meaning and how is it allowed to affect any later treatment? What can they do to you if you are "non-compliant"?

I have a feeling that this may also be related to statistics - eg they have to offer statins to 100% of their registered diabetics, but 20% are non-compliant - ie they refuse to take them. What about the 45% of registered diabetics who ignore the letter inviting them to come in for their regular tests? That is much more non-compliant than Lucy is being! (or much less compliant - awkward grammar!)

Regarding Unbeliever's comment on low-carbing raising total cholesterol - initially on a low-carb diet, particularly if you are in ketosis, total cholesterol may rise, mainly because burning off your own fat can initially increase blood lipids, particularly triglycerides. This is a temporary effect in the initial stages; as you go on low-carbing, your lipid profile will get better and better.

At least, that's how I understand it!

Maybe best not to let her re-test you for about 6 months, Lucy. If yours does go up, she'll be even worse :shock:

Viv 8)

 

[librarising]

viviennem wrote
Regarding Unbeliever's comment on low-carbing raising total cholesterol - initially on a low-carb diet, particularly if you are in ketosis, total cholesterol may rise, mainly because burning off your own fat can initially increase blood lipids, particularly triglycerides

only writing to share my limited understanding.
Low-carbing definitely improves cholesterol levels and ratios, especially by raising HDL and lowering triglycerides.
My recent rise in 'total' surprised me,and sent me back to google.
Seems my rise may be down entirely to a rise in HDL (the 'good' cholesterol) and should then decrease in total as I continue low-carbing.
That should keep the GP off my back.
I'm simply an experiment in progress, looking for the same results others have reported.

Geoff

 

[noblehead]

Does anyone know just what, exactly, being labelled 'non-compliant' means, in its relation to general health care? What is its official meaning and how is it allowed to affect any later treatment? What can they do to you if you are "non-compliant"?

I suppose it would depend upon in what context you were 'non-compliant'. As I said to Lucy earlier the medical profession have a duty of care to treat you when you are ill so doubt very much they could refuse treatment anyways.

When your in hospital and discharge yourself without the doctors consent they ask you to sign a form to say you've discharged yourself, likewise if you refuse treatment by Ambulance personnel, that's not say if you take ill again they won't respond or treat you in hospital but simply covers them from liability if something happens to you......or from being sued!

 

[librarising]

One NHS Trust's policy on non-compliance (all *** added by me)

http://www.ridgeway.nhs.uk/client_media ... cedure.pdf

Interesting excerpts :

1.1 In some cases, patients do not follow their treatment plan. In these
circumstances, it is necessary to have clear arrangements which will ensure the
safety of the individual and make certain that the treatment meets their needs.
This policy and procedure is based on the belief that patients have the right to be
provided with treatment by the Trust which reflects their needs and **********preferences.*************

*******This policy accepts that patients have the right to refuse treatment.**********

3.9 All service areas must identify patients who have a current or previous history of
non-compliance to treatment.
All treatment plans should be devised ******* with the involvement of the patient ********** and
information provided about any treatments and the likely consequence of non–
compliance.
The Multi-disciplinary team (community/inpatient/unit) must discuss and agree an
appropriate clinical management plan for individuals who do not comply/adhere to
treatment.
All reasonable effort must be made to maintain contact with known high risk
patients.
Wherever possible, professionals should negotiate ************ an acceptable treatment
regime ************ with patients who do not comply/adhere to treatment so far as the
treatment regime is safe and will ensure that the patient maintains contact with
the services.

Wherever possible, patients who do not comply/adhere to treatment should have
access to the Multi-disciplinary team (community/inpatient/unit) to ensure that
************** they have access to several health care professionals rather than one to whom
the patient might not respond **************

3.10 Competent adult patients are ********* entitled to refuse treatment, ********* even where it would
clearly benefit their health. The only exception to this rule is where the treatment
is for a mental disorder and the patient is detained under the Mental health act.
When a patient refuses treatment, the patient capacity to understand, for
example, information about the benefits and risk of the proposed treatment and
alternative must be assessed and clearly documented in the clinical notes.
If a patient does not follow a treatment plan, there should be a review of that plan
and the reasons for non-compliance discussed with the patient.

It might be possible to track down Lucy's NHS Trust's written policy, simply by googling it.

Geoff

 

[Unbeliever]

Ssshh Libra rising, Don't put ideas into their heads. My Practice DSN as many others, would gladly have patients who do not obey "sectioned"
They do need to make their targets you know!As the NHS is always right it naturally follows that anyone who disagrees is a danger to themselves and others Where does that leave most of us here?

In imminent danger of detention under the Mental Health Act.!

 

[viviennem]

Wibble wibble wibble :crazy: :crazy: :roll: :lol:

Viv 8)