Meds Compliance: The "Problem" Patient, Meds, and Clinician

I wonder how you might add to your talk some information about other chronic medical illnesses, such as diabetes, hypertension and so on, and how common it is for individuals to be in treatment for those conditions to be medication non-adherant. ( I always lose track of which politically correct term we use to decribe not taking medications as prescribed,...is it medication adherance, med compliance, has it changed again?)

Non-compliance with medications occurs in every condition. From the diabetic who plays fast and loose with their diet and then bolsters themselves with some extra insulin, to the hypertensive patient who stops their B/P meds because they "feel just fine", or to the millions of people who take the first few days worth of an antibiotic and then leave the remainder of the bottle in their medicine cabinet- it isn't just the mentally ill who don't want to be dependent on medications.

It is so important for us to be compliant patients, even when we don't like the side affects, don't like the idea of taking meds., etc. However, there are very few that get their full treatment from a PDoc. Many only get a 15 min. meds. check and their therapy happens with someone other than an M.D. The PDocs are the ones with the full training, education and knowledge to treat us.

A young friend of ours is being treated by a R.N., P.A. - She made a huge meds. mistake last week.

Since there are so many shades of our disorder, and the PDocs are the only ones that have the education to observe and treat us, this may just be a Mental Health Coverage issue.

Nice Post….the only other thing that I would like to add is the cost of the medications. I think it actually plays a bigger role than just the concept that we just stop taking our medications. When a doctor prescribes Geoden for example and there are no generics out yet, you end up looking are a $500.00 to $800.00 monthly bill, just to have them in the house in the first place.

It does not help with the fact that we already feel like we are a burden on the family when our illness flairs up, now we are asking the family to go without in order to get the prescription. Unless you have great health insurance, most of the scripts go unfilled. I think the psychiatrist should know up front before writing any scripts if the patient can actually afford them.

As places like Wal-Mart keep adding more psychiatric medications to their $4.00 plans, I feel more people would be compliant. Anyways…nice article.

Ummm.  I'm confused.  Are we really saying that "yes, we need our meds" and - as the above writer replies - "compliance is so important"?

First of all, there ARE people with the bipolar diagnosis who do well (and better) without meds.  I am one of them, and so are some of my friends, even those diagnosed with schizophrenia.  There's also plenty of research to support this.

Second, "compliance" is really an oppressive term.  It assumes that doctor knows best and that patient should always follow orders from doctor who knows best.  Some people recover despite their doctors, and in fact, some people attribute their self-empowerment and refusal to submit to dominant paradigms as a major force behind their healing.

If you are really going to speak with doctors about compliance, I ask that you consider telling them to enter mutual relationships with their clients, ones based on shared decision-making, and most importantly, ones founded on the principle that the person is the expert on himself/herself.  Thus, the idea of compliance really becomes a vacant term without any substance except to enforce power.

Even for folks who are labelled as being too ill to make rational decisions, the doctor still might not know what's best.  Afterall, we're not really seeing an overall reduction in these disorders, are we? 

It's time we start framing mental health discussions within the context of rights, and that we start considering that people have the right to define their own experiences and direct their own processes without being accused of "non-compliance."   

I'm happy to continue this discussion:  steven@vermontrecovery.com

There are differing degrees of insanity.  Mental illness implies insanity otherwise, you wouldn't be mentally ill.  There are differing degrees.

There are certaintly differing degrees of Bipolarism and as such, not all degrees require medication or multiple forms of medication.  A lot of docs do get heavy handed about the drugs because where 1 might need 5 so does everyone else who walks through the door.  This also plays into why so many aren't med compliant.

Eric makes a very good viable point in that so many can't actually financially afford the prescriptions monthly whether on insurance or not.  Most pharmaceutical companies who offer assistance with meds won't necessarily offer if you have drug coverage from an insurer and yet the insurers do not pay a vast amount of the drug's cost.  Sometimes it really is a choice - roof or 4 prescriptions, food or 4 prescriptions, my spouse's or child's meds or 4 prescriptions.

Finally, most folks with the illness do some type of research about the illness if just only a book or two from the library.  Most folks, at least that I personnally know, do fully realize the consequences of cutting their meds down or going without for whatever reason.  Not all are insane for not considering.

This goes back to the differing degrees.

Oh, and please tell the pdocs and tdocs that it helps if they not only listen to their patients but also "hear" their patients because many of their patients do indeed know themselves best.  A lot of them also do not need certain side effects for certain reasons and that should be enough for the docs not to prescribe those meds that prodominately cause those specific effects instead of saying "well, you can take these 3 meds that do cause such and such or you can go back to the hospital.  You choose."  or "well, the benefits of this will outdo the risks.  Just take them and I'll see you back in 6 weeks."

John, if you are actually reading these

Can you also ask the pdocs and tdocs to actually learn the disorder the same way so that we (the patients) don't get differing diagnoses everytime we see someone?

I ask because in the last 2 years I've had several differing diagnoses and several different methods thrown at me to treat the differing diagnoses whichever individual thought I had.  Granted, the meds are pretty much the same across the board with or without the anti-depressants and yet still.... to go from Recurring Major Depression, to Bipolar I, to Bipolar II, back to Bipolar I, to Cyclothymia, to Bipolar NOS, back to Recurring Major Depression, and finally back to Bipolar I makes a patient think - you know, they don't have a effing clue what is wrong with me so why bother with taking these pills if they can't figure out what exactly is wrong and how to treat it. 

This also creates confusion in family members trying to help us and also creates the impression that "they don't know what is wrong and conjuring up something" mind thought by family members as well.  This then often times puts the patient on the defensive or ends up agreeing with the family members and therefore goes off the meds.

What they all do seem to agree on however, is to shove heavy meds.

Thank You!