Giving the People What They Want

Like many bloggers, I have a stat counter set up for this site and, like many bloggers, I periodically peak at the information that's collected. I've noticed a bit of a trend there. Pretty much once a week, at least, someone finds my blog as a result of a search for a phrase that includes the word, "noncompliant".

"Teaching a noncompliant diabetic," for example.

My blog name is obviously a bit tongue-in-cheek, but also comes from the fact that I have been noncompliant off and on throughout my career as a person with diabetes. I've failed to comply in small ways (those moments that elicit a 'can you eat that?' from others) and big ways (long stretches of nearly double-digit A1c's and a wheelbarrow full of excuses).

Really, though, I chose it because it's such a ridiculous concept and label. I'd say 95% of the population is noncompliant, but about 12 million of us in the U.S. have a genetic switch that flipped either on its own or in conjunction with some lifestyle extremes, and we ended up with diabetes, and our noncompliance took on a new meaning.

The other 5%, well they're the ones eating healthy and exercising, and I look at them with admiration and bemusement as I munch on Cheetos and drink my diet coke.

As a noun, noncompliant is defined as "a person who refuses to comply". In the context of diabetes, of course, that means someone who has been told what to do to take care of their diabetes but is clearly not doing it. The person who developed "Diabetes Made Easy" contends that noncompliance stems from a lack of understanding about the disease. She believes that if people truly knew what was going on when their blood sugar was high, they'd do whatever they were told in order to keep it in range.

I disagree, citing my own experience as a person thoroughly immersed in diabetes information yet still often unable to 'comply'.

Fred Kleinsinger, MD counters the lack of understanding concept nicely in his article "Understanding Noncompliant Patient Behavior". Don't be turned off by his seemingly arrogant statement, "Some of the more frustrating experiences I have had as a physician have involved patients who refuse to follow my perfectly good clinical advice". He quickly rejects his 'repeat it louder' technique for a more patient-driven approach.

The other angle here, in my opinion, is that the perfectly good clinical advice isn't always perfectly good or a perfect fit. When compliance means "do what I say because I say so", then the patient is bound to fail. Again, though, Dr. Fred's advice - which is to ask questions instead of lecture - can counter this particular root cause of noncompliant behavior.

How do you help a "noncompliant diabetic"? Well, if it's me, first of all don't hand me such a label. See me as a partner in my own health care. Help me find support outside of the fifteen minutes I spend with you every three to six months. Understand how overwhelming living this life can be. Perhaps, we focus on one part of my diabetes routine for a while, and go from there. It might take time to bring me back into the fold, and it will take adjustments to the 'approved' routine. You know it's worthwhile and I, even when cloaked in layer upon layer of denial and disregard for good clinical advice, know it too.