Monday, April 26, 2010

Engagement v compliance at the doc's office

I am at an impasse. I moved to AZ 14 yrs ago and have run into so many physicians I don’t respect and whom I fired or who fired me. I am down to one now, an eye doctor (am blind in my right eye due to another one of those and combination of events).

I also should probably have a cardiologist (atrial fib), but I have failed two huge therapies for that—or rather, they failed me!

So I don’t go to a cardio, because I know I won’t do what he or she says.

Jessie Gruman, head of the Health Behavior News Service, wrote the other day about the difference between “engagement” with your doctor and “compliance.”

With all us patients being more inquisitive, empowered, argumentative and maybe knowledgeable, too, just going to a doctor and getting a prescription does not mean we will comply.

A third of people, Jessie says, who get a script don’t fill it. Half of those who fill it, don’t take it as directed.

They are noncompliant, in other words.

Yet, people are more engaged than ever—they look up their ailments, they check side efx of meds, they check alternatives.

Yet, when many people say we should be more engaged with our care, they really mean compliant.

A lot of us are learning the difference.

Jessie has a new website you might like. Check out the Prepared Patient Forum.

Any thoughts on this, readers?


psychiclunch said...

Personally, I think Western medicine has lost a lot of credibility due to the fact that so much has been proven so wrong about it. Trans fats, for example, are the quintessential blunder, having been at one time recommended by doctors specifically for good heart health - and of course now the opposite is true.

These kinds of examples are prevalent, not exceptions. Mercury in vaccines. Aspirin. Aspartame. Disregard for a patient's nutritional intake. Medical and safety testing fraud.

It's either sloppy, or abusive, depending on how you look at the care given by many doctors.

psychiclunch said...

(just a follow-up post to subscribe. Forgot to mark the checkbox!_

Star Lawrence said...

I am very skeptical of medical care, too, but esp out here in AZ compared with DC. I have been here so long, tho, maybe a comparison is meaningless, I don't even know. Yes, it seems like you take some piece of advice, read a study, then a month later, oh, no, that's wrong, you are doomed. I follow the NYT blog as a commenter--do you enjoy that one? Welcome aboard--I post every weekday.

Star Lawrence said...

Check out psychiclunch's websites, readers--very cool.

psychiclunch said...

Thanks for the compliment, Star! I don't think I follow the NYT blog - what's the URL for that? (There must be many categories that NYT puts out...?)

Colleen said...

I say, if the docs incompetent, uncaring, or not in your best interest in any way, don't stop at "non complicance," fire them! Many are outraged that we dare to question them. Well, they need to get over it!

Star Lawrence said...

I have fired every one...except one eye doctor. If I need BP med renewed, can I get it from Urgent Care? Not sure. I tried one more Internist--she was a beeotch, insisting I get weighed or leave. I said I would if I needed a med based on weight. No--leave! So I did. I want a doctor to talk to other docs he or she recommends--like a team that cares about me on an issue. They won't. I have had doctors offer to pray with me instead of tests. I have had one say, even if it is cancer, it'll be slow, come back in six mos. I had to get a managed care consultant to tell me to ask for a CT scan with contrast, which showed it to be a cyst--or at least I assume that is correct because I am still alive 14 yrs later. I had one internist who kept saying, "If you were in the navy, you would not get this test...or if you were in the navy, you could not get this treatment." He was never in the navy! When I was discovered to have atrial fib, the first medicine almost killed me--I was in and out of the hosp for 8 mos. Finally it wore off--half life was 9 mos, I learned. Then they went to coumadin, a blood thinner--and my right retina eventually sloughed off with a big clot in front and back from all the blood tinkering--four surgeries later, this eye is blind. I could go on. This is so maddening. Yes, I question. I am noncompliant. I have a brain.

To go to the NYT "Well" Blog, go to and then to "Health" above... We all comment a lot on about five topics Tara Parker-Pope has for's fun.

Star Lawrence said...

On the NYT site? Go to Health down the left side, not the top.

Star Lawrence said...

Also--you may enjoy...

She's pretty animated...but it's interesting.

Sally said...

Love it...engagement vs compliance. That fits for every relationship I have. Now i will ponder this all day. Thanks,