Adherence. Compliance. And Rubies.
(October 11, 2016)
Proverbs 31:10. “Who can find a virtuous woman? for her price is far above rubies."
I'm willing to bet that the originator of this pithy little complaint is a man. And I suspect that he's the one who gets to decide what the definition of "virtue” is as well. It starts one to wondering about many things. Like, pots and kettles. And – maybe this is just me – but do you suppose that when he finally finds her, the writer actually intends to decorate said virtuous woman with those rubies? or do you think that he might save them for a lady who is maybe a little less virtuous?
Continuing in this vein would probably be a lot more fun to read than what I'm actually writing about today. I’m sorry for that. But we’ll be done soon.
So according to Proverbs, the value and beauty of even precious gems compares unfavorably to the worth of a human being who possesses the rare quality you ardently desire. For doctors, this sought-after person is a patient who actually does what you tell them to do. Meaning that the quality desired would be sticking to a treatment plan, known in the medical biz as “compliance”.
Compliance and the absence thereof is a huge subject in the practice of health care, both conventional and alternative. For example, if I had a dollar for every person I've given an exercise program to over lo these many years who continued it for more than three months, I might be able to buy enough gas to get as far as Clarksville. Additionally, about half of the medications prescribed in the U.S. yearly are taken incorrectly or not taken at all. HALF the pills that the pharmacists hand out aren’t used as intended? Woa.
Most health problems need ongoing attention or lifestyle alteration of some sort. And even small changes, like simply swallowing a pill every morning, are often resisted. Since most of the time doctors have a pretty good reason for asking you to do (or not do) something, silently going your own way isn’t really to be recommended.
In these delicate times, the issue of noncompliance is frequently referred to instead as “nonadherence”, as though they were the same thing. But the words are very different, and the refusal to see that is probably part of the problem. “Nonadherence” is when you simply don’t stick to a plan. “Noncompliance” additionally implies a complaint from Authority that the peasants (or possibly those un-virtuous ladies alluded to above) are refusing to follow rules that their betters have laid down for them. Noncompliance is nonadherence plus attitude.
The thing is, no one likes to be bossed around. Here you've made it all the way to adulthood, and now FINALLY you can stay up as late as you want to and eat pecan pie for dinner every night. At least in theory. Now some DOCTOR has told you to take pills every day, or get up early to do exercise? The grownup part of you says “yeah I should and I will”, but that other part of you screams “nuts!”. Then you "forget" to take your pill or set the alarm clock, and somehow things don’t change.
There are many reasons for noncompliance and nonadherence besides an unruly id, of course. People never have a whole lot of extra time, or money. And most of them – us - like the way we’ve chosen to organize our days and live our lives already. So once your pain disappears, or you first see your blood pressure go down, you really just want the entire disruption that the problem-plus-treatment caused in your life to disappear.
Those reasons, and anything else that gets in the way of sticking to a helpful health plan or treatment, need to be faced head on. Because if you haven’t got your health, you don’t have anything.
So if your doctor cluelessly gives you a protocol to follow that you know up front that you can’t or won’t adhere to, say something right then. S/he may have an alternative that you WILL follow. Or not. But don’t just shine them on. Leave the office with something effective you can do instead, or at least with a referral to a different doctor.
This puts a lot on you. You have to know yourself. If you’re really good at taking pills and lousy at sticking to a diet and don't really want to anyway, maybe pills are the way to go for you. It would be a bad idea to decide you’ll do a diet instead of the pills – then not do the diet. But if you don’t like pills and get handed a prescription, speak up and ask for an alternative. It is ok to be who you are.
Ultimately this is the patient's issue, not the doctor's. You are the one with the problem. And no one can know you, and what you will and won’t do, as well as you. In the end your problems are yours to fix. Get all the help you need to do that, but DO do it, and follow through.
Doctors are trying to help you. We’re all trying, even if we annoy you in the process. Talk to us. Help us help you. If your treatment isn’t working out, find one that does. Everyone is unique and irreplaceable. Your price – and your health -- IS beyond rubies. Even if you aren’t especially virtuous. Heck, maybe especially if you aren’t.
--dr. diane holmes
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