A 21-year-old female patient presents to the office for an annual exam. She has had normal, regular menstrual cycles since she was 14 but she has not had a menstrual cycle in over 6 months. A pregnancy test is negative. The FNP wants to order blood work to determine the cause of her secondary amenorrhea. When the patient hears that if all is normal the treatment will be giving progestins to initiate a menstrual cycle, she tells the FNP that she cannot do that because she does not believe in birth control pills. The FNP tries to advise the patient that it is not birth control pills, but a hormone to assist in regulating her periods and the patient leaves the office crying. What does the FNP do now to help this patient?
Sample Answer
Discussion
Patients have the right to make decisions regarding their own treatment; thus, the right to refuse medication. Therefore, it is unlawful and unethical for clinicians to force or trick patients into taking medication. However, clinicians have a duty to help patients make informed decisions and consent (Haskins & Wick, 2017). Therefore, they can recommend, advise, suggest, or urge the patient to comply with the treatment plan. If a patient refuses to take the prescribed medication, the first step the clinician should take is to establish why the patient refused the medication. This helps the clinician decide the best approach to helping the patient take medicine. In this case, the patient does not believe in contraceptives; thus, won’t use them even to treat hormonal imbalance.
The clinician should first confirm the patient’s diagnosis through a blood test and imaging tests to help the patient understand their diagnosis better. In the current care, the patient is suspected of having secondary amenorrhea. Since the pregnancy test is negative, there is a need for a thyroid test, ovary function test and a prolactin test to confirm the diagnosis. There will also be a need for ultrasound and MRI to assess for abnormalities in the internal reproductive organs, which would indicate a need for referral to a gynecologist. Suppose the ultrasound and MRI show reversible abnormalities in reproductive organs such as tumors and structural blockages. In that case, the clinician can recommend a surgical procedure or refer the patient to a gynecologist for further evaluation (Jaeger, Hüther & Steinert, 2019).
If not, the next step would be explaining to the patient how the medication will manage the condition and the evidence-based risks and consequences of not taking the prescribed medicine. This will help the patient make an informed decision. If the patient still resists the treatment, the clinician can recommend lifestyle changes to manage the illness and refer the patient to a gynecologist for further evaluation. Some lifestyle changes that can help manage the condition include moderate exercise, a balanced diet, rest, and stress management (Pereira & Brown, 2017).
References
- Haskins, D. R., & Wick, J. Y. (2017). Medication refusal: Resident rights, administration dilemma. The Consultant Pharmacist®, 32(12), 728-736. https://www.ingentaconnect.com/contentone/ascp/tcp/2017/00000032/00000012/art00003
- Jaeger, S., Hüther, F., & Steinert, T. (2019). Refusing medication therapy in involuntary inpatient treatment—A multiperspective qualitative study. Frontiers in psychiatry, 10, 295. https://internal-journal.frontiersin.org/articles/10.3389/fpsyt.2019.00295/full
