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The Compliance Problem

Hopefully you’ve read the post comparing doctors and mechanics, because this post will continue along that theme a bit. When your vehicle’s owner’s manual tells you to change the oil or transmission fluid on regular intervals, you do, or you face the consequences.

I went to the mechanic 5 months ago and he noticed that my brake calipers were wearing out and that they needed to be replaced. I didn’t really listen, mostly because I couldn’t afford the work at the time, or some other excuse. Well, that ended up costing me in the end, because my brakes ended up needing more extensive repairs (costing so much more than the original repair would have) because I didn’t fix that problem. Similar situations can exist in medicine. Doctors give recommendations, whether to prescribe treatment, outline post-op care, guidelines for wound or pain management, etc. Doctors usually know what they’re talking about, and give the recommendations and prescriptions they do out of experience, research, training, and a desire for our well-being. But, for some reason, we don’t always listen.

Boot at my entrance way

I have often wondered how well I would follow the instructions I give when recommending treatment with my patients. Most of the time, patients have no difficulty with the instruction I give, as I try to be very clear and make sure they understand. Yet, sometimes, compliance (or following doctor’s orders) isn’t easy. Sometimes it doesn’t matter, and sometimes it does.

Let me share an example from a friend (X) who underwent surgery. No, X is not my patient. I would hope that this could never happen to one of my patients, and I don’t know that I would publically call out one of my patients, just my friend. Eight months prior to me taking this picture, X underwent a rather simple procedure to repair a tailor’s bunion (see earlier blogpost). X subsequently failed to listen to the doctor’s recommendation of taking it easy, and is still in the walking boot. X’s non-compliance led to a fracture (or break) in one of the bones in X’s foot, which then required more time in the boot to heal. The problem can be seen from the picture: X isn’t always wearing the boto appropriately. X lamented on Facebook 4 days after her doctor’s appointment, “2 more weeks in a boot. I guess my occasional sprints up the stairs weren’t such a good idea and now I am being forced to rest and ice more”. My first thought was talking back to her, “no, you’re not being forced to do anything, your doctor is just informing you about how to actually heal appropriately!” What should have been a six week recovery has instead been a six month process because of X’s impatience to get back to preferred activities.

My friend X isn’t the only non-compliant patient in the world. We come up with lots of reasons why we don’t need to follow doctor’s advice. But, try trusting your doctor. Follow the counsel, and maximize your chances for recovery and healing. At the very least, it will make your next follow-up appointment much less awkward, since you won’t need to confess your non-compliance, but will be able to tell your doctor how wonderfully you have followed instructions. Such compliance also helps to identify other complications.

If a patient is experiencing unexpected pain or other complications, the doctor will first ask if the patient is following all instructions. If not, that’s the place to start. If you are following instructions, and still experience complications, diagnosing the problem will go so much faster if the doctor doesn’t need to go through the extra steps of re-prescribing the original treatment first.

I will say that it isn’t always the patient’s fault! The title of doctor comes from the latin word docere, which means to teach. It is the doctor’s responsibility to teach the patient. Are you being taught?