Playing With Fire: Seeing "Noncompliance" In A New Light
Here's a bird's-eye view of what we in the healthcare professions tend to dismiss as a patient's "willful failure" to follow his or her treatment plan. The lessons learned are not only valuable to the writer as a patient, but as a nurse who will never use the term "noncompliant" in the same way again.
I guess it was meant to happen. Another failed experiment....another life lesson learned.
Like most people in the healthcare professions, I make a lousy patient. I sometimes skip doctor visits and manipulate my medication schedule to suit my convenience. I don't always follow the guidelines I've been given for healthy living, such as getting proper amounts of sleep or wearing my amber glasses in the evening to trick my brain into thinking it's time for bed. And there are times when I even forget my meds or simply don't bother with them, figuring "just this once" won't kill me.
And then there are the times I play with fire.....like trying to reduce my medication dosage without first consulting with my healthcare provider.
Yes, I did it. One day recently, I got a wild hair and decided that since I'd been stable for over six weeks, I could cut down on one of my psychotropics---the expensive one, which, as it turns out, is also apparently the one that holds me together.
The consequences were immediate and disastrous; suddenly it felt like I was on an out-of-control carnival ride, barreling toward Hell in a rattletrap seat with a broken safety belt. I became angry and agitated, paranoid and sleepless, weepy and irritable by turns. I'd only halved the dose, but it was as if I weren't taking any at all; so intense were my symptoms, in fact, that I briefly considered leaving the house and driving as far as I could, as fast as I could, with the radio cranked up and all four windows down---ANYTHING to get rid of that squirmy, restless feeling.
Thankfully, I figured out pretty quickly that I was experiencing withdrawal---I'd cut too much, too fast---and within a couple of days after returning to my usual dose I was back to normal. Now when I go to my appointment tomorrow, I'll probably blurt out something like "Forgive me, Doctor, for I have sinned", but more importantly, I've learned a valuable lesson from the experiment: namely, that we healthcare professionals should think twice before we slap a label of "noncompliance"' on our patients.
I've never liked that word anyway. Who are we to dictate how other people should live? We can recommend a course of action, even strongly, but we are not the arbiters of what should constitute a "healthy" lifestyle for them. Medications can be costly or hard to take, or they carry unacceptable side effects. Exercise and a nutritious diet are out of reach for some, for a myriad of reasons. Even quitting a harmful habit, like smoking or excessive use of alcohol, is difficult at best. And if the perceived rewards don't seem like they're worth the effort, why bother?
That's not to say that being healthy isn't a worthy goal in itself. I know that being sane is a really good thing for me personally---and I risked it because I seized on something my doctor said months back about someday trying to dial back on this particular drug. But for the average Joe or Jane who lacks the advantage of knowing exactly what he or she is doing when choosing not to follow medical advice, it's not always a "willful" failure to comply with treatment.
There's a lot of ignorance, and yes, stupidity out there; if there weren't, we wouldn't need to put out the same public-service announcements every summer about the danger of leaving kids and pets in hot cars.
We may know a dozen good reasons why we shouldn't adjust our own med dosages, but the average consumer doesn't. We may understand the basics of good health, but people who haven't taken all the science courses we did may not have even the most basic knowledge of the scientific principles involved in weight loss or preventing childhood diseases.
Just look at all the misinformation in the popular media about health issues. It's especially bad on the Internet, and among other things it's caused frightened patients to avoid doctors and use prayer, strange rites, and so-called 'alternative' or 'natural' medicine to treat illness.....sometimes with devastating consequences. It's also caused parents to forgo immunizations for their children because of a now-debunked theory that the vaccines might contribute to autism. These people aren't "noncompliant", they merely need the correct information.
Of course, sometimes it doesn't matter how much we educate, a patient's going to do what he's going to do. We see that all the time with nursing-home residents who require oxygen 24/7, except for those brief "timeouts" when they can be seen on the facility's patio, puffing on a cigarette. We see it in patients whose drug of abuse is food---the only substance a human being can't give up entirely.
We can also see it in our own behaviors, as we sometimes feel helpless too......and it's that helplessness that drives a great many healthcare consumers to do things that are NOT in their (our) best interests. It's a way of maintaining some control over our lives in the face of health problems that demand great changes in the way we conduct those lives. And in a lot of ways, it's even a form of self-preservation......and if that's "noncompliance", so be it.
In the meantime, here's one nurse who won't use that term anymore. I also won't be tinkering with my meds again anytime soon....not because I'm afraid of being labeled, but because it was a really stupid thing to do. 'Nuff said.Last edit by Joe V on Sep 4, '13
About VivaLasViejas, ASN, RN Guide
VivaLasViejas has '20' year(s) of experience and specializes in 'LTC, assisted living, geriatrics, psych'. From 'The Great Northwest'; 58 Years Old; Joined Sep '02; Posts: 26,415; Likes: 42,065.Sep 4, '13Viva, I think your new career direction will be in writing. You should consider a blog of your own.Sep 4, '13I have one, but it's strictly therapeutic and "non-profit". My psychiatrist reads it to find out what's REALLY going on with me.Sep 5, '13Bahaha! I do that with my anti-depressant every couple years. After all, I'm not depressed. I obviously don't need it. Never mind that I'm not depressed because I'm taking my anti-depressant. And if a patient were to tell me the same thing I'd point out the obvious to them, but for me, why not TRY????Sep 5, '13When I have patients who do this, I think, "Gee, that was stupid." For myself I only think, "Gee, that was stupid," after I'm back on my meds. Double standard. I'm working on it.Sep 5, '13Quote from NurseDirtyBirdYep, you nailed it! So why do we always seem to figure it out only after the fact? I wonder sometimes how come I keep thinking I can defeat this @&#*! disease by sheer force of will, but I'm still trying....When I have patients who do this, I think, "Gee, that was stupid." For myself I only think, "Gee, that was stupid," after I'm back on my meds. Double standard. I'm working on it.Sep 6, '13Because that is what we are acculturated to believe......Quote from VivaLasViejasYep, you nailed it! So why do we always seem to figure it out only after the fact? I wonder sometimes how come I keep thinking I can defeat this @&#*! disease by sheer force of will, but I'm still trying....Sep 7, '13Great article Viva!!! When's that blog coming???
I used to get uncomfortable with anyone using "non compliant" I just GAGGED typing it!!
I don't recall using the word in my career; because of my clinical rotations at area hospitals in my area, our instructors drilled to NEVER use "non compliance" as a term at all; in my PN and my BSN program.
As one who knows how to be that "horrible pt"that can keep my fellow peer in their toes when they see that I am a nurse, and state it like "I should understand", I give them a lesson that they never forget an let them have it!
But I digress.
When I deal with me, as a patient, it has taken me YEARS to not toe near the heat.
When you have a doctor state "I know you don't like pills" and recall yourself saying that to a patient, you know you are in IT, at least I know.
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