Compliance
I have to say that it doesn't help the burnout factor when 75% of the patients I see in clinic are drug seeking (I wish I was just being cynical, however this is surprisingly true in our patient population). It also doesn't help when a large majority of all my patients are also non-compliant.
Ah. Non complaince...
What does this term mean, you ask? Literally it means they don't comply with instructions. There are levels of this. Obviously, as a physician, I am not the boss of a patient, however the issue of non-compliance can be very frustrating on many levels.
Sometimes non-compliance is a physician's problem: e.g. a patient comes and says they are depressed. The just want to talk about it. The Doc prescribes an anti-depressant, thinking if the came to the Doc they obviously want meds. The patient, not wanting meds one bit, doesn't fill this prescription and leaves feeling dissatisfied. The follow up visit patient is still depressed, and upon hearing that the patient hasn't taken their meds the doc, not really understanding the real issue (obviosuly this is not a family doc) chalks the patient's persistent issues up to non-compliance.
Sometimes, non-compliance is the patients problem. A diabetic who has failing eyes, failing kidneys, and multiple amputations should be taking his insulin. He knows he should be taking it. But he doesn't because he doesn't feel like it. It's a pain in the butt counting carbs and shooting yourself up. So his sugars stay high, he risks losing more limbs, and now is in the hospital with a heart attack that may have been prevented if he had just taken his insulin. We catheterize his heart, stent a blocked artery, put him on his supposed home meds plus a blood thinner - explaining, of course the reasoning behind each and the importance of all. He looks great, we send him home in decent shape, then he comes back two months later, stent glogged, sugars sky high, and here we go again...
Sometimes it's a communication error. Doc says you have high blood pressure, take this pill. You (the patient) say ok and takes the pills just when you feel bad, which surprisingly isn't all that often. Then you comes back to the doctors office and your pressures are still sky high. (this scenero is amazingly common and sometimes hard to tease out. If this issue is missed then sometimes doses are upped and and the patient's blood pressure becomes notoriously hard to control when i reality, it's just a compliance issue).
That's compliance in a a very simplified nutshell (other Docs feel free to contribute). And it's this issue of non-compliance that has been killing me lately.... That, and all the drug-seeking chronic pain patients allergic to everything under the sun except that one medicine that begings with d and ends with ilaudid. This issue could be ten posts long, but I'm just going to let it go, because my gentler readers can only handle so much cynicism.
Update later on horrible no good rotten birthday weekend and the excitement and redeeming power of co-residents on my birthday proper. With pictures I hope.
What does this term mean, you ask? Literally it means they don't comply with instructions. There are levels of this. Obviously, as a physician, I am not the boss of a patient, however the issue of non-compliance can be very frustrating on many levels.
Sometimes non-compliance is a physician's problem: e.g. a patient comes and says they are depressed. The just want to talk about it. The Doc prescribes an anti-depressant, thinking if the came to the Doc they obviously want meds. The patient, not wanting meds one bit, doesn't fill this prescription and leaves feeling dissatisfied. The follow up visit patient is still depressed, and upon hearing that the patient hasn't taken their meds the doc, not really understanding the real issue (obviosuly this is not a family doc) chalks the patient's persistent issues up to non-compliance.
Sometimes, non-compliance is the patients problem. A diabetic who has failing eyes, failing kidneys, and multiple amputations should be taking his insulin. He knows he should be taking it. But he doesn't because he doesn't feel like it. It's a pain in the butt counting carbs and shooting yourself up. So his sugars stay high, he risks losing more limbs, and now is in the hospital with a heart attack that may have been prevented if he had just taken his insulin. We catheterize his heart, stent a blocked artery, put him on his supposed home meds plus a blood thinner - explaining, of course the reasoning behind each and the importance of all. He looks great, we send him home in decent shape, then he comes back two months later, stent glogged, sugars sky high, and here we go again...Sometimes it's a communication error. Doc says you have high blood pressure, take this pill. You (the patient) say ok and takes the pills just when you feel bad, which surprisingly isn't all that often. Then you comes back to the doctors office and your pressures are still sky high. (this scenero is amazingly common and sometimes hard to tease out. If this issue is missed then sometimes doses are upped and and the patient's blood pressure becomes notoriously hard to control when i reality, it's just a compliance issue).
That's compliance in a a very simplified nutshell (other Docs feel free to contribute). And it's this issue of non-compliance that has been killing me lately.... That, and all the drug-seeking chronic pain patients allergic to everything under the sun except that one medicine that begings with d and ends with ilaudid. This issue could be ten posts long, but I'm just going to let it go, because my gentler readers can only handle so much cynicism.
Update later on horrible no good rotten birthday weekend and the excitement and redeeming power of co-residents on my birthday proper. With pictures I hope.
posted by Beta at 3:09 AM
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