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Almost every patient hits a point in his or her treatment when s/he asks “Why am I even doing this? Is it even helping me?” When this occurs, the decision to remain in treatment, question treatment and/or stop following recommendations (quit taking medication, refuse to set up appointments, etc.) is not unusal As I write this article, I am recovering from foot surgery. For eight consecutive days now I have essentially been sitting or lying down 24 hours a day with my foot elevated and iced. My own desire to stop doing what I’ve been told has reminded me that many of people must face this same feeling of doubt and uncertainty about following doctor’s orders. Why People Stop Following Orders There are many reasons why people stop following doctor’s orders or treatment recommendations. I will explore some of them, as well as my insights as a psychotherapist and nurse, after practicing with clients of all ages for 19 years. Ø You don’t see any visible change. If you repeatedly follow a medication or other medical regime for months with no obvious change, it is understandable why you would (and should) question the rationale. Talk directly with your health care provider about what you expected would happen, what you were told, and what you’re experiencing. Be as specific as you can about symptoms, side effects and anything else you think we should know. It is likely you need another approach, treatment, or even a second opinion. Either way, SPEAK UP! You are paying for a service and you deserve adequate treatment.
Ø You’re too busy. This is a commonly cited reason for people not following exercise plans, meal plans, or most any treatment recommendation requiring a change in your schedule or lifestyle. Change is hard. There is an abundance of literature on how and why people make changes in their life. Prochaska and DiClemente, two researchers on change, have identified four stages of readiness for change. If you have an interest in this literature, please look them up. The important thing for you that they’ve learned is that clients do better when their treatment is tailored to their stage of readiness. In other words, it’s foolish to set up a meal plan for someone still in denial about how their eating is affecting a health problem like diabetes, heart disease or anorexia nervosa. I believe our “busyness” is more a reflection of our unreadiness to change than our actual schedule. Make a true effort to move things around in your life that you can before you decide you’re too busy. On the other hand, what your provider is asking may be more than you can (or are ready) to do. Ø You don’t believe it’s going to work. When I explore someone’s noncompliance to treatment recommendations, I am often told this. It’s okay to be somewhat skeptical of anything new (medication, diet, psychotherapy). However, if what you’ve been doing isn’t working for you, you owe it to yourself to at least give the recommendations a fair trial run. Ask about the actual likelihood this will make a positive change in your life, based on the provider’s other clients, research, and percentage of patients responding favorably. Knowing this may help you reconsider. If you give it an honest effort and it doesn’t change the condition, talk to your provider about other options. Ø You don’t understand how it will work, what it does, etc. Again, this is a commonly heard complaint. It is the provider’s job to be clear and explain the treatment, recommendation, medication, etc., until you understand it. Don’t feel stupid if you have to ask more than once what they mean. Medical jargon can be very complicated and unclear, and you should feel comfortable asking for clarification. I am always impressed when clients ask questions; it tells me they’re bright and interested in their own healthcare. Also, clients are more likely to follow through on instructions if they understand why they’re doing it. Ø The instructions are not clear. When people go to a consultation, they generally recall about 50% of what was told to them. The likelihood of recalling what they heard goes up when the instructions are WRITTEN so ask for a handout on the information, or write it down yourself. When I meet with clients and give them new information or treatment recommendations, I almost always have them write it down before leaving the office. Clients who understand what to do are more involved in their treatment and have a better result. Ø My doctor/provider doesn’t talk to me or understand me. Poor communication can be on the provider’s end, the client’s end, or both. The provider must be able to explain in ways you understand. It is essential that you know your disease, the symptoms, how to manage them, etc. Your provider needs to be able to adjust his/her language and attitudes to fit your personality as well as possible. That said, not all providers and clients are a good “fit.” If this seems to be an ongoing issue (and not just a bad day for either of you), you owe it to yourself to consider a different provider. Clients who report feeling satisfied with his/her provider are more likely to follow treatment recommendations from them. These are a few of the most common reasons people struggle with listening to and following through with their doctor’s orders. I hope this has been helpful in understanding that you are not alone in your uncertainty, but it is often helpful to both you and your provider to talk directly about your concerns. You owe it to yourself.
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