I am extremely fortunate to work with a nurse who has over 20 years of experience. She knows how to run an efficient clinic, she gives great insight into our patients, and I really feel like we're a good team. She's funny, she's helpful, and she's very honest.
I see Hepatitis C patients, and many of them have substance abuse problems - active or in the past. In order to treat their Hepatitis C, patients need to be sober from all substances for at least 6 months. Most people have gotten over their addictions, which is why they are coming to see me - they are on their way to cleaning up their lives.
Yesterday, I saw a patient with Hepatitis C who is an alcoholic. He is still drinking, despite knowing about his liver disease. His wife is also a drug addict. He can't drive because of a suspended license, so he relies on her to take him to his appointments. You can imagine that she is not the most reliable driver; she is often gone for days at a time on binges. He had to cancel 2 previous appointments with me because she wasn't home. He told me that there is a divot at the foot of his bed where he spends nights sitting up, waiting for her. Very sad.
I was telling my nurse about the patient and about how I wished there was something we could do for him - get him to AA meetings, help his wife get sober, etc. She shook her head and looked at me. "I know you're new at this and all, but you know there are some people you just can't help. You can only do so much." She's right, I just have a hard time holding patients responsible for their actions; I tend to treat them as children who don't know any better. However, patients make bad decisions all the time - and they make bad decisions knowing that they are bad decisions! Whether it's substance abuse or not following their diabetic diet or not taking their blood pressure medications, my patients are adults and I might serve them better if I held them to higher standards. I'm certainly not helping them by dismissing their weight gain, their drinking, their noncompliance as reasonable choices. I'll need to learn how to be a little firmer on some of these things.