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Doc Talk

Doc Talk: Putting Off Seeking Care

Sometimes people seek care before they really need to it.  Other times they don’t seek care when they need it.  The later scenario ends up being far more costly to the health care system.  When illnesses go untended they can spiral into lasting disabilities requiring nursing home placement.  Intensive care stays result when people ignore the fact that they are ill and put off seeking medical attention until they are too sick to deny it any more.

People put off seeking care for a number of reasons.  Here’s what to do about some of the most common culprits.

    1. Naiveté: signs & symptoms:  This matter can be resolved by simply educating the ill person regarding the meaning of symptoms and hazards of letting them go untended.  Better yet, educate people about common conditions before they get sick!
    2. Stoic independence:   This requires a reality check, a conversation about how independence might be lost as a result of letting symptoms go untended.
    3. Frugality: This implies the need for a conversation regarding the current cost of escalated illness which could be avoided through early intervention.  The argument needs to triumph over denial and the emotional safety it affords.
    4. Lack of sufficient insurance: This is a practical concern.  People need to show a source of pay before care is rendered in many clinic settings.  Sometimes referral to mission clinics is needed.  People need to know how to access county services for guidance.  Putting this information in newsletters is a nice way to give people information and simultaneously protect their dignity.
    5. Fear of diagnosis and its implications: Denial, a favored coping mechanism of many people is often grounded in fear.  Emotional support and chastening need to be balanced cautiously.
    6. System mistrust / bad memories:  If someone has been traumatized by past health care experiences, it is important to relay this history (with permission) to the care provider.  It is  important to offer advocacy and presence when vulnerability is magnified by illness.
    7. Care giving / chore demands: This too is a practical concern.  Chastening won’t help resolve the chest pain of a farmer who fears the crops won’t be harvested if they seek care now.   Ill caregivers need urgent access to practical helpers. Consider developing a congregational yellow pages for ready reference in situations where caregivers need rapid access to care.
    8. Reluctance to bother MD:  A very common concern of stoic people is that they might be regarded as a whiner or a wimp if they seek care before their symptoms escalate.  Stoic people need “permission” to bother MD.  They are more inclined to seek care as a favor to someone else than they are to seek it for themselves.
    9. Familial defiance:  Many times family members find themselves at a loss to persuade a spouse or parent to seek the care they need.  Power struggles become amplified when vulnerability is being experienced with illness.  An outside party is sometimes needed to resolve this. In these situations family members are crying for advocate assistance. 
    10. Reluctance to re-bother MD:  Time and time again parish nurse notes reveal that “reluctance to bother” becomes amplified tenfold once a prescription has been issued for a condition.  Nurses routinely report that they have stepped in as advocates to obtain new prescriptions for people who simply didn’t want to report that the prescription wasn’t working because they were ashamed to admit it. 
    11. Shame or guilt: Sometimes people seem to blame their own inadequacy for the lack of resolution.  They don’t want to be perceived as a whiner or a wimp when side effects are intolerable.  They would prefer to stop taking the medicine and hope for the best without telling the physician for fear of offending them.  There are times when advocacy is needed for physical or emotional safety.  This bears no reflection on the physician unaware. 
    12. Difficulty expressing concerns:  Sometimes people need help to communicate their concerns clearly because they become anxious and cognitively cloudy in the presence of the physician.  This is where writing the concerns and questions down prior to a visit becomes most helpful.
      Telephone standby assistance is also helpful for getting past the triage desk.
    13. Lack of transport:  Sometimes access delays are merely attributable to a lack of transport.  People need to know before they are sick where they can call for help if they become ill.
    14. Apathy / Fatigue / Depression:  All of these states of low motivation can contribute to access delays.  People with these traits need to be watched closely for untended illnesses.
    15. Confusion: When illness is manifest in confusion (whether it is related to medication toxicity, cerebral confusion or stemming from another cause) are apt to not recognize that they need help in a time when they need it the most.  When confusion is untended it can lead to all sorts of mishaps. For this reason parishioners at large need to be aware that they have an advocacy role to play when someone they care about is confused.  They need permission to step in when fear of intrusion is a concern.  They need to understand to potential consequences of letting confusion go untended.  They need to step up to the role of vulnerable adult reporters.