COMPLIANCE

Today is a good day to discuss “compliance.”  I saw my doc yesterday and she administered a screener for depression which I failed.  Of course, I’m depressed.  Wouldn’t you be if your motor skills were vanishing in front of your eyes?  Tomorrow, I’m scheduled for a cervical epidural and I may need a multi-level cervical fusion.  That’s depressing, isn’t it?

Of course, it is!  These days there are plenty of reasons to be depressed.  The doc wants to start me on antidepressants and in counseling.  For sure, I don’t want more meds.  I’m already taking pills every 3 hours.  Some of my pills are meant to counter the effects of others.  Adding one more doesn’t make sense.

I’m a strong believer in counseling; but, realistically, how is counseling going to help with Parkinson’s and Degenerative Disc Disease?  I guess the counselor will work on my perceptions of my illness.  Will it help?  Time will tell.

I asked Dr Rosen for her opinion and help with my health issues.  She gave me her opinion.  My choices are to comply with her treatment or ignore it.  Over the years, those patients who complied with my orders did well while many of those who were non-compliant did poorly.  Despite my doubts about counseling and meds, I’m going to choose to comply with her plan and see how I do.  After all, I’m now the patient and asking for the doc’s advice; and ignoring it would be silly.  It would assume that I know more than the doc and you know what they say about assumptions.  To assume often makes an “ass out of u and me.”

We’ve talked about the patient’s role in getting well and maintaining their health and wellth.  Compliance with your doc’s advice is critical.  Almost as important as compliance is making sure your doc knows when you are non-compliant.  Let me give you an example.  Doc S has diagnosed Patient A with hypertension and heart disease.  Doc S prescribed two meds for his elevated pressure, one of which will also protect A’s heart.

On a follow up visit, Patient A fails to tell his doc that he is not taking his meds regularly.  A’s BP is markedly elevated, so Doc S stresses how important controlling A’s BP is and gives A stronger meds.  Meanwhile, A decides to comply and starts on the new meds.  Two days later, he passes out at work, cuts his forehead needing sutures and suffers a mild concussion. The ER documents hypotension (low BP) secondary to his meds and reduces his dosage to his original dose.

Had Patient A been compliant from the onset, he would have skipped the ER and done well.  Had Patient A told his doc that he was non-compliant, the doc could have simply reviewed the importance of taking his meds and kept him on the starting dosage. Either way, A wins if he is upfront and honest.

I’ve sent many patients for counseling and have seen marked improvements in patient wellbeing following counseling.  I’ll start counseling next week and give it a month.  I informed my doc that I would be willing to take an antidepressant if she really felt it would help.  She agreed to put additional meds on hold for the time being.

Here’ your joke for the day:

This is probably one of the most worrisome statistics to emerge in recent years.

25% of the men in this country are on medication for mental illness.

That’s scary.

It means 75% are running around untreated.

There was an old guy who took suppositories as a medication. One time he went to a restaurant with his wife.  She said, “What is a suppository doing in your ear?” The old man says, “Oh! Now I know where my hearing aids are!”

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