LAST week I wrote about being “non-compliant”; of how some people cannot or will not comply with treatments. There are actually many facets to this subject, all of which fall under one label.
Is it a fair label or categorisation? Is it a big generalisation of certain types of people that puts them at a disadvantage? Should we put ourselves in their shoes to understand their situation?
There’s this perception that if only the patient would follow instructions and take their medications as they should, they’d get better. After all, these treatments and medications have been tried and tested.
When a person is categorised as “non-compliant”, there’s something negative about it. A mark is made on his medical file that the doctor and medical staff instantly recognise, and inevitably, the first thing that will flash in everyone’s mind is that the person is trouble.
There are also people who’ve been labelled as non-compliant because they don’t take their medications as instructed. They are the ones who would most likely return for medical attention when they become sick.
Some people stop medications immediately because they feel better instead of following a step-down protocol that would not shock the body’s system. Others have their own interpretation of their illness and, would adjust their medications according to how they feel that day.
Many people would like to be their own doctor, using the actual doctor they visit as a guide to what they believe, what they’ve read and what a friend-of-a-friend’s-cousin-who-was-once-sick-but-is-better-now did. This doesn’t make it any easier for the doctor because he too sees many patients every day.
CASE STUDY
Let’s take a look at one patient’s point of view. Her name is Josie (not her real name) and she’s in her 70s, with uncontrolled diabetes that has led to end-stage kidney failure where she has to go for haemoldialysis.
She also has a heart condition, hypertension and high cholesterol. Some people call it “the full package”. As if that’s not enough, she had cataracts that were operated on. She was happy that her sight was restored. However, several years later, as her general condition worsened, she developed glaucoma and became partially blind. Her sight has become just light, partial darkness and shadows.
Whenever I visit her, Josie always engages me in an animated conversation about her day. Then, she’d show me the amount of medication she takes daily. The sight of all her pills is quite daunting. She has to take them five to six times a day, before and after breakfast, lunch and dinner. Oh, and another one half an hour before sleeping. Unsurprisingly, she is sick of taking all these pills and often wishes she could stop.
Her routine is even more spectacular. Imagine her week — three days a week for haemodialysis that takes four hours per session, physiotherapy for her legs, doctors’ check-up (and she has had a few so that it all averaged to about one hospital visit a week), blood tests that need to be done a week or two before the check-up, blood sugar finger pricks at the start and end of each day, and again when at the doctor’s, and remembering which medications are about to finish, which new course to start and which to taper down to end.
She also has to remember to cut down her intake of salt, sugar and fat, as well as preservatives and flavourings. Sometimes she cheats and dares to live dangerously. She eats out and orders from the menu. She feels that her life has become too restrictive. That’s when she gets into trouble and her doctors will chide her for it. When this happens, she becomes really sad and sorry for herself.
IMPORTANCE OF EMPATHY
It’s not easy for Josie to follow all of the doctor’s orders sometimes. Understandably, she feels that her life is not her own anymore. It’s one thing to strictly follow everything, it’s quite another to deal with the emotional side of it.
Do you know how tired a person can become after a haemodialysis treatment? This alone can affect them physically and emotionally. When someone like Josie gets labelled as being “not fully compliant” because she didn’t adhere to what the doctor ordered, just take a moment to realise how difficult it is for her to remain fully compliant.
There are just so many hours in a day, and there’s so much to be done just to get the body running as it should. As much as it’s complicated to balance the medications and treatments for patients such as Josie, we should remember and understand how it’s just as difficult for her to balance all of this. Don’t be so quick to scold. Take a step back and be a little kinder.
Putri Juneita Johari volunteers for the Special Children Society of Ampang. You can reach her at juneitajohari@yahoo.com