tag:blogger.com,1999:blog-26666124.post434780233392160489..comments2024-03-18T03:28:36.581-04:00Comments on Shrink Rap: Guest blogger Dr. Jesse Hellman on Non-Compliance. Sort of.Unknownnoreply@blogger.comBlogger10125tag:blogger.com,1999:blog-26666124.post-11451663230936637752013-04-11T18:43:01.801-04:002013-04-11T18:43:01.801-04:00This comment has been removed by a blog administrator.Anonymoushttps://www.blogger.com/profile/08461320268748849566noreply@blogger.comtag:blogger.com,1999:blog-26666124.post-65025088209042738072013-04-01T08:02:48.669-04:002013-04-01T08:02:48.669-04:00Sarebear,
I am sorry you are having such a rough t...Sarebear,<br />I am sorry you are having such a rough time. I am glad to hear from you, anyway, I was beginning to wonder if you were okay. I read your blog post, it sounds like you are having rough time. Feel better soon.Dinahhttps://www.blogger.com/profile/09227988351623862689noreply@blogger.comtag:blogger.com,1999:blog-26666124.post-79381357000668263552013-04-01T01:26:58.261-04:002013-04-01T01:26:58.261-04:00"Why would anyone even expect someone to &quo..."Why would anyone even expect someone to "comply" with taking a medication or undergoing a treatment that makes them feel worse? "<br /><br />That's been the story of my treatment for quite some time now, and when the stabilizer is making you bleed from bladder and/or kidneys, and three docs in one week and a half all say keep taking it plus some generic Ditropan, cause if you don't you'd be so manic you'd do things you couldn't live with and then kill yourself, well, worse is relative.<br /><br />However, after three months of following that advice, heck i'd told my GP that taking the Lamictal, I was starting to be able to be aware of my kidneys, could feel them just from discomfort, from time to time, he said keep taking it. So I did, he deferred naturally to psychitrist as he ought. However, three months later and I'm in constant abdominal discomfort and pain, can feel my kidney(s) on an almost daily basis, and even a slight lowering of Lamictal dose caused, within a day, a shockingly noticeable improvement in symptoms. Going back up caused a noticeable return to the previous level of symptoms. So all the docs who told me the drug doesn't do that . . . well, I'd spent most of a year having things get worse and listening to that, keep taking it though it makes that worse. Still better than dead, I guess, however it got so bad we had to stop it anyway.<br /><br />Posted a bunch more about it at my blog, but when you say why would someone take something when it makes you feel worse . . . well, you sometimes have to weigh the lesser of two evils. However, I'm at that point again, and frustrated . I wish it was as simple as complying or not but I'm in a land of grey.<br /><br />http://sarebear.typepad.com/blog/2013/03/currently-fighting-full-blown-mania-and-suicide.htmlSarebearhttps://www.blogger.com/profile/09208596053319110470noreply@blogger.comtag:blogger.com,1999:blog-26666124.post-68309337552404465732013-04-01T00:58:19.447-04:002013-04-01T00:58:19.447-04:00I don't know how people would even go about st...I don't know how people would even go about studying this topic because I know even with myself there have been different reasons for non-adherence at different times. Once it was because I felt good, got busy, and just didn't think about it so I missed some doses. Once I decreased a dose because of side effects and didn't want to call the psychiatrist and bother him since it didn't constitute an emergency, even if he would have been okay with it. Once I didn't get an antibiotic filled because I decided to just wait a little longer and see if it was a virus, and it was and I got better without it. <br /><br />I don't make a habit of not following directions but there have been occasions, as I'm sure is the case with most people, where I have not always adhered to the recommendations. I suspect a lot of non-adherence is simple forgetfulness. I don't know how many times I've asked myself did I take the dose already today or not, and then I don't want to risk over doing it. Those pill boxes come in handy for forgetful people like me.<br /><br />Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-26666124.post-58053529591413672332013-03-31T14:59:45.225-04:002013-03-31T14:59:45.225-04:00Why would anyone even expect someone to "comp...Why would anyone even expect someone to "comply" with taking a medication or undergoing a treatment that makes them feel worse? <br /><br />Sometimes the medical world uses the term for those who won't stop smoking or stay on a specific diet, as though people choose to have unhealthy habits the way they purchase a shirt, and the term does not take into consideration the struggle involved, more for some than for others.<br /><br />I think what the term does is loosens the liability and responsibility the doctor has for controlling the behavior of others. We don't necessarily think badly of patients who don't do what we suggest, but documenting such things does imply that we're less responsible for the outcome, and that seems okay.<br /><br />I, like Jesse, don't use the term because I do think it has a pejorative/judgmental edge. The only time that I care if a patient does not do what I suggest is if they call me repeatedly in distress (especially if there is screaming, sobbing, and catastrophizing involved on weekends) and then don't do what I suggest. I prefer quiet non-compliance. But "I feel better on a lower dose," is not non-compliance. Dinahhttps://www.blogger.com/profile/09227988351623862689noreply@blogger.comtag:blogger.com,1999:blog-26666124.post-9479011525353107242013-03-31T12:11:27.901-04:002013-03-31T12:11:27.901-04:00"Non-compliance" does sound bad, as thou..."Non-compliance" does sound bad, as though there were an assumption that somehow patients have some sort of moral obligation to comply.<br /><br />But I don't read it that way any more, not after having read various articles and posts discussing treatment strategies and noting that "non-complaiance is an issue with [such-and-such a recommendation or medication]." This use of the phrase makes it clear that the problem is not seen to lie with the patient. So now I read it strictly neutrally, as an observation of behaviour with no implied judgement of motivation.Alison Cumminshttps://www.blogger.com/profile/06370841996857073237noreply@blogger.comtag:blogger.com,1999:blog-26666124.post-36670857353395740322013-03-31T12:11:27.404-04:002013-03-31T12:11:27.404-04:00@Anon: excellent point. Often the patient adjusts ...@Anon: excellent point. Often the patient adjusts medication in a way that works better. Good treatment is a collaboration. Often a patient will suggest a medication and often it proves to be a good choice. For instance, a depressed patient might say "my sister has similar symptoms and has had good results from sertraline. Should I try that?" So in that case not only is there the possibility of a genetic connection between the symptoms but a positive expectation of results.<br /><br />BTW, Brian M above is a link to an advertisement (or something worse). Don't go there!jessehttps://www.blogger.com/profile/11077223398907532291noreply@blogger.comtag:blogger.com,1999:blog-26666124.post-51811035111486363892013-03-31T12:09:41.641-04:002013-03-31T12:09:41.641-04:00This comment has been removed by the author.jessehttps://www.blogger.com/profile/11077223398907532291noreply@blogger.comtag:blogger.com,1999:blog-26666124.post-68828175943399234982013-03-31T09:38:09.290-04:002013-03-31T09:38:09.290-04:00I think, in most cases, it's non-adherence ver...I think, in most cases, it's non-<i>adherence</i> versus non-compliance, however non-compliance <i>is</i> also an issue.<br /><br />If I loathe you as a psychiatrist but am forced to see you, I will be non-compliant with my meds on the first opportunity I get. Terminology here is correct, I'm intentionally refusing to comply with your decision on my forced treatment.<br /><br />If I'm having awful side-effects from a medication, noticing myself approaching hypomania, etc. I will stop medications or lower doses as necessary. In such a case, I'm being non-adherent, not non-compliant. There's no protest, no ill intent, I'm simply making a judgement on what's best for me at a time when I think I cannot reach you.<br /><br />I think the distinction between the two is important especially as a simple word can taint one person's view of another, and both are worth exploring, non-judgmentally, with the client to see what their motivation is and where it stems from.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-26666124.post-7125780786748764492013-03-30T22:36:07.249-04:002013-03-30T22:36:07.249-04:00Really, it's up to the patient to make the fin...Really, it's up to the patient to make the final decision. I know some of the nasty side effects i've received from taking anti-depressants in the past. It's not much fun. It's really up to the patient to decide what they want to do based on the expert advice they receive from their doctor or psychiatrist.Brian Mhttp://panicandanxietyhelp.comnoreply@blogger.com