Should We Label Patients as Non-Compliant?

A patient comes into your clinic hypertensive, hyperglycemic...hyper everything for an infected foot wound.  His blood pressure is through the roof and the clinic's glucometer registers a glucose reading of 300+.  Not to mention the stinky puss oozing from the patient's left great toe.  The infected sore is obviously a complication of this patient's "non-compliance" the NP and physician mutter to each other.  If he had kept his blood sugar in check an everyday blister surely would not have become this infected.  But can we blame him?

The term 'non-compliant' is thrown around clinics and hospitals on a daily basis.  We say it with a tone of disdain as if our patients had followed our instructions completely their health problems would be cured, or at least properly managed.  And, maybe this is true.  But, I think when it comes to discussing non-compliance, we need to become more understanding and less self-righteous.

Most people don't want to be unhealthy.  They want to succeed in managing their medical conditions and feel well.  In practice, however this can prove difficult.  Our patients take a lot of medication.  Popping pills three, even four times a day is a hassle.  Some must be taken before eating, others after.  Some while standing, others lying down.  With some medications you must check blood sugar or blood pressure prior to taking them.  Properly adhering to medication regimens can become quite a ridiculous act.  The process of administering one's own medications must be simply exhausting.  I don't blame patients who get sick of the whole routine and only 'comply' with the regimen their providers have prescribed inconsistently if at all.

Then, there are side effects.  Medications prescribed to control diabetes, for example can cause GI upset- diarrhea in particular.  Blood pressure medications leave patients feeling lightheaded and low on energy.  This is enough to make one feel depressed about one's lot in life...enter Prozac and it's associated drowsiness and erectile dysfunction...time to add in Cialis.  Patients are taking medication upon medication just to control the side effects of the few pills they actually need.  Even though drugs improve numerical values associated with health such as blood pressure and blood sugar, they often make patients feel worse.  Why not just stop taking them all and enjoy life- even if your risk of heart attack or stroke increases?

Our patients may not all be educated, particularly in the medical field, but they do have the smarts necessary to make their own decisions.  It is our responsibility as nurse practitioners to give them the information they need and send them out of the clinic to make their own choices.  To some, it may be worth avoiding the daily hassle of medication management and unpleasant side effects to die happy but at a younger age.  Others may take your advice and chose a more complicated but healthier lifestyle.  It's up to them.

Next time you say the term 'non-compliant' with a distasteful tone in your voice think about your own medication closet filled with bottles of half-finished prescriptions for antibiotics.  It just might put you in your place.

Comments

I disagree with your perspective. Non compliance is a real issue to poor outcomes in healthcare, but also it is lack of understanding of the treatment plan, disease process and expectations or responsibilities of the patient. Sometimes these need to be reiterated, reinforced, reviewed, with lots of encouragement and support. Patients need to understand their decisions or inaction could cause their healt the deteriorate, and following expert advice can improve their health. We can work together if we are both honest and have a mutual understanding of each of our responsibilities and expectations. Plans can be individualized and modified to meet our patients needs. When my patient is not following directions, I determine in the interview what additional education my patient needs or how can I modify the plan to make it easier to follow and achieve optimum health. I also practice in pediatrics, so this is quite an endeavor at times. Many people have to be involved in the plan, sometimes many households with competing lifestyles and beliefs. Sometimes, it is an issue of neglect or lack or resources. Non compliance implies that we turn our backs in disapproval, and blame our patients for their poor health, it is far from that. I feel it is my failure to do my job properly, it reflects poorly on my rapport with my patient, my education was inferior or not well understood, my lack of understanding of my patients ability to carry out the plan. You did not address this topic fully. I am a little further down the road than you and wanted to offer another perspective.

Rainey

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