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Beyond Compliance, Adherence, & Concordance – Supporting The Patient’s Implementation Of Optimal Treatment

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I Am Non-Compliant And It Sucks

May 7th, 2007 at 7:38 am · · Patient's Role · 1 Comment

Blog Recounts Compliance Challenges Of Bipolar Blogger


Graphic from Master of Irony


The Master Of Irony Blog

Master of Irony is a good example of patients writing about their experiences with a treatment regimen that can be as difficult to manage as the disorder being treated.

“Just Me” is the sobriquet of a blogger who has been diagnosed with bipolar disorder and is herself a mental health worker. Her blog includes much more than patient compliance issues but adherence plays a fundamental role in so many aspects of the life of anyone with a chronic disorder that it inevitably becomes a part of and is sometimes the primary focus of many entries in this blog.

The title of this post, “I Am Non-Compliant And It Sucks” is lifted from a message written to Just Me that triggers a full-fledged consideration of patient compliance at Dear Just Me, the post that initially caught my attention.

Since then, however, at least two postings have also dealt directly with compliance:

An excerpt from the latter entry is characteristic and poignant:

When my meds do not behave (see last post) and frustrate me, I have to start reciting reasons to not even think about giving up on them. Taking meds just isn’t fun at best. Taking psychotropics is even worse than most meds because of the side effects. Taking meds when your body is like mine and every med is a new adventure into weirdness is even harder. But after the first 11 months I accepted that my body doesn’t react normally and I’m so used to it that I forget this is the reason behind the frustration and that the frustration is not because of the meds themselves. …

I am 31 years old. Thanks to bipolar I have taken nearly 40 kinds of meds in 5 years. You do the math.

The posts are thoughtful and clearly if casually written,1 and, at least by my reading, demonstrate a growing self-awareness that is endearing.


Commentary

I recommend Master of Irony and some other patient-generated blogs both for the solutions to specific noncompliance problems they may offer and, even more significantly, for the insight they provide into the psychological processes attendant to compliance management from the patient’s point of view.

As is true of blogs in general, blogs written from the point of view of patients range from barely coherent to admirably lucid.

In addition, these healthcare-permeated blogs, by their nature, may be composed of rants about incompetent doctors or paeans about clinicians who became the means of salvation, invectives about overdependence on drugs or the advocation of one or another medication that was key to improvement in one case or another, invocations of spiritual or mystic powers or cynical dismissals of any treatments that doesn’t carry the AMA seal of approval, etc., etc., etc.

Some discernment on the part of the reader is necessary.

Nonetheless, I hold that blogs such as Master of Irony and Sick Girl Speaks offer an an unparalleled opportunity to garner a sense of how compliance works – or doesn’t work – without the layers of conscious or unconscious distortions that may prevail in a face-to-face meeting between a patient and physician.

Reading such posts is a shortcut to understanding that took me years of experience to accumulate.



Footnotes

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  1. Yesterday’s post, for example, begins “No more puking so I figured it was time to get a post up that did not focus on that.”

Tags: Patient's Role

1 response so far ↓

  • 1 Master of Irony // May 7, 2007 at 8:37 pm

    Thanks so much for the really nice post. I have thought about this and smiled all day long. It’s really good to see someone listening to and understanding that compliance just is not as simple as taking a few pills every night. It’s not. So often we mentally ill are told that if we just take pills we’ll be better. If meds don’t help then somehow we have failed. If we don’t want to take a given med for one or another reasons then it is our fault that treatment is not working.

    I remember building that trust being the hardest thing with my psychiatrist. After all we’ve been through she now trusts me enough to not question compliance and to know I will tell her if I am not taking something and there is a good reason behind it. But years ago I remember being furious with her because I wasn’t doing well taking meds that were making me sick and she was questioning my motives.

    Anyway, thanks again. You really made my day, and I’ll be interested to read more of your site.