What Does “Non-Compliance” Mean?
I always wondered about “non-compliance.” In my medical school training, this discussion comes up all of the time. We create plans with patients and at the next visit they have been unable to complete the plans. Take, for example, determining the proper insulin dosage for patients with Type 2 Diabetes. To do this effectively, we need to have blood sugar readings at 4 intervals during a day for at least 3 days. We explain this to patients – I’ve even drawn out schedules – but often patients return for their next visit with few if any blood glucose measurements. Why is it that during patient visits we discuss plans that variably work? What happens either in our communication at the visit or in patient follow-through that results in patients not getting better? What is it really like to live with a chronic disease?
This year, I left my hospital-based rotations to join the Coalition to work with the Care Management Team seeing patients at home. My weekly home visits with Mrs. P have started to shine a light on thinking about “non-compliance.” She is a woman with diabetes and depression who uses a wheel chair for mobilization. She is kind and endearing.
At our home visits(check out who else is talking about home visits), we always talk about her family – mostly her grandbabies – and about her time working at Campbell’s Soup. We also check her blood sugar at each visit. I used to think checking blood sugar was easy, but Ms. P has shown me how it could be a daunting task. First of all, she has 3 or 4 different glucose monitors that all operate differently and need different supplies like test strips and lancets for their use. She gets these supplies for her monitors in the mail or from the pharmacy and somehow there is always something missing — either the strips or lancets run out faster than the other thus rendering the monitor useless. Some of the monitors are difficult to use. At times, to get a reading, we need to prick her finger and use the monitor three or four times. Not to mention, to navigate her small first floor is difficult with a hospital bed, bedside commode, and other furnishings serving as bulwarks to her movement. It is hard for her to even get to her monitors.
I thought about the many times I have pleaded with patients to check their blood sugars and now I wonder how many of them are in situations like Ms. P — that this “easy” task is actually quite hard. I thought about how I would feel about patients who I felt weren’t taking care of themselves – hopeless, lazy, “non-compliant”. I thought about how I might have made them feel during our visits – not heard, misunderstood, not empowered. Ms. P. has shown me it is necessary to be more understanding of patients’ needs and to take extra time to communicate with them about their reality of their chronic disease.
I think we, as providers, should be more mindful in coming up with creative solutions for patients. Perhaps, we need community health workers or other health providers to visit patient homes more often. This way, providers see the obstacles, can try solutions, and then see if they work. A case study for one person might inform other patient interactions making the whole practice better. Not to be cliché, but the possibilities gained by learning more about patients are endless!