Gary McClain, PhD, is a therapist, patient advocate, and writer who specializes in helping clients—as well as their family members and professional caregivers—deal with the emotional impact of chronic and life-threatening illnesses.
Jane is meeting with her physician in a few minutes. She’s in the waiting room right now. She’s feeling a little jittery. A symptom of her medical condition? No. More like a symptom of lack of compliance.
Jane’s regimen includes a medication that needs to be taken daily, an hour before lunch, and another that needs to be taken in the evening. Some days, Jane is just too busy to follow that routine. And don’t even mention the diet and exercise routine that never quite became a routine.
Last month, Jane answered, “Yes, for the most part,” (with her fingers crossed) when her doctor asked about compliance. She’ll probably do that again today. Her physician, in turn, may recommend that Jane continue her current regimen assuming that Jane is following it. Or she may review Jane’s test results and conclude that the regimen isn’t working, and consider changing it. She may wonder why Jane isn’t improving and order additional testing, which means time and money. But her doctor might also question whether Jane is telling the truth.
Whatever the outcome, Jane and her physician both lose. She is at risk for not getting the best possible care for her condition. And Jane’s lack of openness means her doctor is essentially working with one hand tied behind her back.
8 tips to help you talk to your doctor about your treatment plan failures
1. First, remember that your doctor is a professional. It’s easy to fall into feeling like your doctor is an authority figure who, if displeased, might pass judgment or punish you. (And yes, your doctor may “strongly” express his/her concern.) However, you and your doctor have a professional, adult relationship. And you are on the same team.
2. Drop the labels. Beating up on yourself is dis-empowering. So you can stop calling yourself names like lazy, careless, etc. You’re human. This is not about whether you are a good person or not. Something isn’t working and you and your doctor need to have a talk.
3. Come prepared. Take a moment and think about where you were compliant and where you weren’t, what was hard for you about being compliant, and what was not so hard. Jot it down. These are your talking points for your appointment.
4. Come clean. Rather than looking at a discussion about your lack of compliance as a confession, think of yourself as presenting a problem for you and your doctor to solve together. That means that hemming and hawing and apologizing don’t have a place here. Instead, look your doctor in the eye and provide the facts. “I haven’t been totally compliant. I want to talk to you about this.”
5. Zero in. Provide your doctor with a brief snapshot. What aspects of your regimen you have been complaint with and where you haven’t. In that order. Doing your homework ahead of time will help you to speak in a concise and direct manner, and will help your doctor to better assess the situation. Lay out the facts. It’s that simple.
6. Ask for suggestions. Now that you and your doctor are on the same page, let the problem solving begin! After you have answered any additional questions your doctor may have and, yes, gotten a “talking to,” ask your doctor if he/she has any suggestions to help you maintain compliance. Questions might include: “Can you give me some suggestions for how I can be more complaint with that?” “Can you tell me what has worked for other patients who had the same issue?” “Any support resources you might want to point me toward?”
7. Consider negotiation. If your regimen isn’t working for you, it may be time for an adjustment. When you consent to your doctor’s recommend treatment plan, he/she is assuming that it is acceptable. But if it isn’t, it may be possible to negotiate with your doctor. It can’t hurt to ask. It’s as simple as: “It’s especially hard for me to ____ because ____. Can we adjust this in a way that’s a better fit for me?”
8. Come to an agreement. Before you leave your doctor’s office, make sure you have an understanding of what your regimen will look like going forward. Along with what your physician is expecting in terms of compliance. Know what you have committed to. This will result in better use of your time, your doctor’s time, and avoid wasted medications and unnecessary testing. Efficient use of healthcare resources means better care for you.
Look at compliance not as a chore, or a punishment, but as the road to taking the best possible care of yourself. But like any road, there may be some bumps, curves, and even detours along the way. Being compliant is a process.
Team up with your physician to develop a compliance strategy that works for you. And then work at it.