Lessons from Non-Compliant Patients

I have seen patients die – from uncontrolled hypertension, treatable urinary infections, curable pneumonia.

What do many of these patients have in common? Some (though not all) simply did not take their medicine.

It’s not that they didn’t have a remedy at hand – they just didn’t comply with medical advice, either out of negligence, misunderstanding, disbelief, financial restraints, or rebellion.  Doctors call these patients non-compliant.  Physicians do not want to be responsible for patients who will not take care of themselves, and often use the term “non-compliant” to document patient irresponsibility.

Fortunately, most patients who don’t take their medicine do not die. Having had the opportunity to treat many patients for 10-20 years, some of whom are definitely non-compliant, I have seen what people can sometimes “get away with.”  They don’t teach this in medical school.  Students assume people will naturally do what a doctor thinks is good for them.

Yet many of them don’t.  People want to think of themselves as healthy.  Though they may know hypertension is “the silent killer,” since they feel OK, why worry about a blood pressure that’s 220/110?  This highlights another common denominator:  a person’s motivation to treat a condition is highly correlated with the degree of current (or feared) suffering.

Over the years I’ve seen a handful of patients unwilling to treat their diabetes, with resultant blood sugars consistently in the 400-500 range.  This is far out of control, yet certain people exhibit few symptoms.  Though I’ve had no one admit this, my suspicion is some of these patients enjoy the weight loss extreme hyperglycemia affords, and the “freedom” to eat large amounts of food.  Although these patients are playing with fire, some live with this condition for years.  While this is NOT the proper way to treat diabetes, I relate this to reassure my (Type 2) diabetic readers that without medicine, things may not be as dire as you might suppose.

Likewise, I’ve had hypothyroid patients neglect to refill their prescriptions.  Most do fine at least for months – often for several months, sometimes for years.  As I discuss in detail in my self-study course on hypothyroidism, symptomatic thyroid deficiency will not develop overnight.

How many times have you heard: finish ALL your antibiotics The compulsive patient will do so, as will the severely ill.  But the average patient with bronchitis, an earache, a urinary infection, or strep throat does not.  They take them until they’re feeling better . . . and perhaps a day or two more.  What have we learned from this?  In many cases once the immune system kicks in, further antibiotic use is non-essential.

And then there’s asthma – some patients discontinue their medication when they clearly shouldn’t.  But many stop their inhalers when they’re feeling better, despite medical advice to the contrary – and do just fine.

I am NOT saying to stop your medicine. My intention is only to reassure those who are worried.  Ideally, readers will discuss their concerns with their own doctors.  For example, you might ask your physician, “What would happen if I ran out of my diabetic medicine?”  It’s not a “one size fits all” type of answer, and is well worth finding out now, when options are many.

As the angels always seem to say, “Do not be afraid.”

Copyright © 2011 Cynthia J. Koelker, MD

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About Cynthia J. Koelker, MD

CYNTHIA J KOELKER , MD is a board-certified family physician with over twenty years of clinical experience. A member of American Mensa, Dr. Koelker holds degrees in biology, humanities, medicine, and music from M.I.T., Case Western Reserve University School of Medicine, and the University of Akron. She served in the National Health Service Corps to finance her medical education.
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