Tuesday, 25 October 2016

Why is this Patient NON-COMPLIANT?!

Image result for physician and patient communicationWhat does it mean when we say that a patient is 'non-compliant' with his or her treatment plan? Usually, this refers to the fact that they are not following what they should be doing to manage their health conditions. Of course, we can see how frustrating this can be for healthcare professionals to deal with. After all, how can we make patients better if they aren't even doing what they should be?!

The issue, however, is much deeper than what appears on the surface. The key to working with a patient who is seemingly 'non-compliant' is to actually reframe the situation - and to understand that 'non-compliance' needs to be explored.

First, let's consider the fact that 'non-compliance' means that the patient is not doing what we told them to. Well, this alone is problematic! Patients need to be at the CENTRE of our care.

Therefore, if we prescribe them a treatment (this could be a medication, a lifestyle change, etc.), and they are not motivated or convinced to change or implement the intervention, they simply will not do it. To a healthcare worker, this may seem like noncompliance. But really, perhaps the patient did not understand the plan properly. Or maybe there are barriers that are preventing them from following the advice, such as financial issues, lack of motivation, no social support, underlying medical or psychiatric issues, etc. If we don't explore these further, we will simply mislabel patients as being noncompliant - and then no one benefits.
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Another thing to remember is that noncompliance can stem from frustration or previous experiences. Let's say your patient needs to start a certain medication, but they have heard from others that this pill gives them so many side effects and trouble. Are they likely to take it? Probably not. Or what if the patient previously tried something similar and it did not work, and now they have lost hope. Again, we may immediately brush this off as being noncompliant. But without exploring these issues with patients, we will never be able to understand their experiences, opinions, and values. Thus, we will never be able to provide truly effective, safe, and compassionate patient care.

Image result for open communication healthcare quoteAt the same time, patients need to be open with their physicians. It is important for patients to let their doctors, nurses, etc. know WHY they are hesitant to follow their treatment plan, including any challenges that they are experiencing. This can be hard, as patients may feel embarrassed, they might not 'want to talk about their problems', or they might feel that this is not 'important'. However, open communication between patients and their healthcare providers is CRITICAL! It is only through these discussions that we can formulate a plan that works best for our individual, unique patients.

So, in theory, the term noncompliance really shouldn't even be used. It is not that the patient is 'not compliant', as this indicates that the healthcare provider alone is dictating what treatments should be followed; in reality, the regime is decided upon and discussed between the patient AND the healthcare team. Furthermore, noncompliance indicates an underlying issue of some sort, and needs to be explored further to determine what the TRUE factors are. Finally, open communication, honesty, and respect are the only ways through which therapeutic relationships can be established between patients and their providers, and through this, we can ensure that our interventions are patient-cantered and lead to positive health outcomes - a benefit for patients and their physicians!

Image result for nelson mandela if you talk to a man

Tuesday, 4 October 2016

Write It Out!

I love to write. When I wrote my first book a few years ago, it was a long and tiring process. But my passion for sharing information and my experiences in words drove me to continue to write, page by page, until I had an entire book!

I also love to journal. Writing down about my vacations, school year, or even just my day is fun for me. I like to look back on my journal and read through what I did two or three years ago - it is quite nostalgic for me!

We've talked before about how sharing or expressing our emotions is important. When we talk about our feelings and label them, we feel better. We are better able to cope with our experiences and to handle difficult emotions.

What about writing down our emotions? Does this have any effect? Well, this study is one example that shows that writing down our emotions can actually have important effects on our mood and functioning. In this study, participants were about to take a math test. Half the group were given a piece of paper and pen and told to write about how they felt before the test. The other half didn't write about their emotions. Interestingly, the group that did not write about their emotions (but were anxious) showed a relationship between their anxiety and marks. In other words, anxiety without writing about it was related to lower marks. BUT, those who wrote down about their worries did not show a relationship to their mark. So, those who wrote about their study performed as they normally would have, regardless of their anxiety.

What does this mean? In simple terms, it means that when we write down our emotions, we do not allow them to control us or to screw our experiences and perceptions. We are able to identify our emotions and move on. However, when we don't express our feelings (for example, through writing), we get bogged down, and this affects our functioning and experiences.

So, does this mean you must write down every single emotion you experience? No, not at all. In fact, even just verbally speaking about your emotions is helpful. But it does serve an important to be able to write down about how we feel. If you can, try getting a journal (or even use an app on your phone!) and begin writing about your day and your feelings. When you are encountered by tough situation, take time to write about it and identify your emotions as they are. I guarantee that you will realize a big difference in how you are able to cope with the emotion and the entire experience. You will be able to understand what exactly you are feeling, why this situation is making you feel that way. Then, you can ride through the emotion and take steps to make the experience less distressing/difficult for yourself. Similarly, writing about the experience after it is over can help you reflect and realize what you learned from it, how you dealt with the whirl of emotions, and what you can do differently next time.  Even if it is ONE WORD such as 'ANGRY!", you will still feel some relief in identifying the emotion.

Try it today! Grab a pen and paper (or your finger and your phone....), and try writing down how you feel!