Being Straight With Your Doc When You Haven’t Done Your Part

Dr. Gary McClain
Written by
Dr. Gary McClain Mental Health

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 adherence with her treatment regimen and self-care. 

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 adherence.  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. 

So, this is a relationship? 

The cornerstone of any relationship, professional or personal, is trust.  And that begins with honesty.  Here’s how to make that adherence discussion less difficult: 

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 their concern.)  However, you and your doctor have a professional – adult – relationship.  And you are on the same team.    

Drop the labels.  Beating up on yourself is disempowering.  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.   

Come prepared.  Take a moment and think about where you were adherent and where you weren’t, what was hard for you about being adherent, and what was not so hard.  Jot it down. These are your talking points for your appointment.   

Come clean.  Rather than looking at a discussion about your lack of adherence 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 adherent.  I want to talk to you about this.” 

 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.  “I have been adherent with ____________.  I have not been adherent with ______________.”  Lay out the facts.  It’s that simple. 

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 adherence.  Questions might include: “Can you give me some suggestions for how I can be more adherent with ___________?”  “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?” 

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?” 

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 adherence.  Know what you have committed to.  This will result in better use of your time, your doctor’s time, and avoiding wasted medications and unnecessary testing.  Efficient use of healthcare resources means better care for you. 

Look at adherence 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 adherent is a process. 

Team up with your physician to develop a adherence strategy that works for you.  And then work it. 

Dr. Gary McClain
Written by
Dr. Gary McClain Mental Health

Dr. Gary McClain, PhD, is a psychotherapist, patient advocate, and author, specializing in helping clients deal with the emotional impact of chronic and life-threatening illnesses, as well as their families and professional caregivers. He works with them to understand and cope with their emotions, to learn about their lifestyle and treatment options, to maintain compliance with medical regimens, to communicate effectively with the medical establishment, to communicate better with other family members, and to listen to their own inner voice as they make decisions about the future. He writes articles for healthcare publications and websites, facilitates discussions in social health communities, and conducts workshops on living with chronic conditions, Chronic Communication. Visit his blog for more on mental health at Connect with him on twitter @drgaryjgd 

This article is for informational purposes only. The content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek medical advice from your physician or health provider for your specific needs.

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