I never wanted to believe it would happen to me. Oh sure, I was warned it would happen, but I always felt it would only happen to those other doctors. Those doctors don’t have my patients. My patients are invested in their care and motivated to do well.
However, the studies don’t lie. It’s universal. Everyone struggles to take medicine as it is prescribed. It has been known for quite a while that the majority of patients not only do not take their medicine as prescribed, worse yet, many don’t take it at all. The cost of dealing with medication misuse is staggering. It’s a huge problem.
Whenever I think about patients not taking their medicine as prescribed (the doctor word for that is “noncompliance”) a certain patient always springs to mind. I have known him a long time and we have developed a great relationship through the years. As a result, he was the last person I would have suspected to struggle with taking his medication as directed. Through the years we have had many discussions as to what motivates such behavior. Still, he finds it hard to break from his noncompliance.
I remember asking him for the first time years ago why he struggles with taking his medicine. His answer was the same answer I get from every patient when asked; “I just forget to take it.” However, it’s never, “I forget!” Applying even simple CSI techniques (stolen from television so I am sure they work), it was easy to become skeptical that he was telling the truth. He usually wore pants. He could remember that task. His teeth were brushed and he appeared to have bathed, so those tasks can be remembered as well. There were no signs of dementia, although I may want to consider testing for that next time we talk. I asked if he remembers to wear seatbelts in his car. He assured me he does. Every time. So a selective memory defect just doesn’t make sense. What other reason could it be if it is not; “I forget.”
Patients struggling with adhering to their medicine schedule always have a reason for it. Always. The difficult task for the physician is to attempt to open the eyes of their patients to the reasons they themselves have. Some people go along nicely, others go along with that attempt kicking and screaming. In the end, nothing is more rewarding than to have a revealing discussion that unlocks the real reason why someone is noncompliant. After the real reason comes to light we can start the process of removing roadblocks and making positive change.
Through the years I have heard every reason, rationalization, excuse, whine and fantasy in the book for being noncompliant. In no particular order, I have found that these are the most common:
- For some, they simply have no transportation to the pharmacy or lack the funds to buy their medicine. No shame there. When it’s medicine or food, you have to make decisions.
- Many elderly patients are on several medicines, each with its own dosing schedule, that when combined would give King Solomon himself difficulty keeping it all organized.
- Some say they see their parents taking a hand full of pills and have sworn to never become like them. After seeing their parents, I don’t blame them.
- Some feel to take medication means they are getting older and they are simply not ready to admit they are aging.
- Similarly, some feel to resort to medicine means they have failed somehow. To be honest, I have never understood that one. Stubborn pride runs deep.
- Others feel that if they have no symptoms at the moment, there is simply no need to take medicine. Wait until you feel bad, then take pills seems to be the predominate thought.
- Many feel there must be some other way to become better besides medicine. Sometimes they are right. Sometimes they are wrong.
- A few have a simple mistrust of the medical profession as a whole. They always make me wonder why they came to me in the first place. Far too many fear more “what might happen” if they take a pill, than fear what will happen as the consequence of untreated illness. Thank you Google.
- Treatment doesn’t always work and some loose hope there is anything out there that can help them, so why bother.
- For some, taking a needed medication would interfere with job performance and could jeopardize their employment. Understandable.
- Many have decided to leave the healing in God’s hands and place their faith there rather than in medication.
I could literally go on all day with this list but you get the point. It’s never, “I forget.”
That’s what has made dealing with my long time patient all the more difficult. He has none of those reasons. However, I’m not giving up. With enough gentle prodding, and hoping he does not get mad at my probing questions, one day I will uncover the reasons known only to him that are driving his behavior. The hope is that once those reasons are discovered we can begin the work of tearing down those roadblocks together.
I think one day we will. I ought to know. I am that patient.