Life - With Diabetes - Goes On

Since I last wrote about Living With Diabetes,¹ that blog has added more posts to its conveniently categorized “Compliance” section.

As I noted previously, these blog entries provide useful insights into a patient’s perspective on compliance that are not often available to a clinician during a treatment session.

I’m especially taken with an observations on the difference between disagreeing with a treatment recommendation and noncompliance as limned in these excerpts from Patient Gripe - Bariatric Surgery Suggestions

For good measure there are a couple of comments that enthusiastically endorse this notion.

So do I.

I have long promoted, especially in How To (Correctly) Not Take Medications As Prescribed, differentiating between noncompliance (whatever that term means these days) and a communicated and acknowledged non-execution of a specific treatment recommendation.²

While all manner of humanistic, sociological, and ethical principles can be invoked in support of this idea, my primary argument is based on clinical pragmatism:

The opportunity cost (in this case, the potential loss of improvements in the patient’s health that the recommendation would have hypothetically caused) of the patient not following the recommendation is more than compensated by the elimination of (some of) the changes patients unilaterally and surreptitiously make in the treatment plan. Because these deviations from the presumed treatment plan are unknown to the clinician, they are especially likely to lead to mistaken diagnoses and erroneous evaluations of treatment outcomes (e.g., a physician may assume a patient’s infection is resistant to the prescribed medication or that the original diagnosis was wrong because of lack of response when the actual cause was the patient not filling the prescription), which, in turn, lead to delays in or prevention of improvements in the patient’s health, geometric increases in healthcare expenditures, and damage to patient and clinician morale and the patient-clinician relationship.³

Clearly, there are situations in which coerced compliance is justified; e.g., the treatment of deadly, highly communicable diseases and the treatment of patients with serious disorders who are cognitively unable to realistically appraise their condition. In the majority of cases, however, automatically categorizing a patient who refuses a treatment recommendation as noncompliant, with all the connotations that term carries, is, at best nonproductive, and is likely to inhibit - and perhaps destroy - treatment.

The Life With Diabetes posts can be found at Living With Diabetes On Compliance

Footnotes

1. See From The Patient’s Point Of View [back]
2. Yes, “communicated and acknowledged non-execution of a specific treatment recommendation is a particularly awkward construction, but a more felicitous phrase, devoid of loaded words, doesn’t come immediately to mind. [back]
3. See the “Complex, Cascading, Cumulative Costs” Section of Complex, Cascading, Cumulative Costs [back]

• Importance Of Individual Variations Over Time In Diabetes Treatment
• Organizing Data About Factors That Affect Compliance
• Pharmacist-Driven Compliance Enhancement Programs
• Connection Between Knowledge and Compliance Unclear
• LIFE Program Enhances Adherence