Monday, November 20, 2006

Compliance

Last night on call I was paged by a nurse because one of the patients in our coronary intensive care unit was threatening to leave against medical advice. The man had severe heart disease, plaques growing by the day, clogging off his arteries because of his smoking, diet, and unfortunate genetic predisposition. He'd already had a heart attack even though he was young, but he didn't see the need to stay in the hospital when, after a few pills, he felt so much better.

At times like these, it's my job to lay the smack down.

"What's the trouble, Mr. X? Why are you planning to leave?"

"I'm 42 years old and I can eat whatever I want. This place is terrible. If I want bacon for breakfast, I can have bacon for breakfast. If I want to smoke, I can smoke. I'm 42 years old."

He was, of course, acting 4 decades younger than his stated age. I attempted to explain to him in no uncertain terms that bacon was likely going to kill him and that we preferred it not be today. I don't know if he really understood what I was talking about or not. The concept of risk factors and cumulative behaviors contributing to disease aren't compelling when his past experience so emphatically impressed on him the memories of wolfing down saturated fat to his, umm, heart's content with nary a chest pang. It's the same conversation I've had a million times with smokers who with fallacious logic stubbornly refuse to understand that there are any real consequences at all.

It's a problem that results in poor "compliance"--the term used to connote how well a patient adheres to the treatments recommended by the doctor. Some patients are non-compliant because of financial concerns, some because the don't understand the instructions, and some because they're too darn lazy to go fill the prescription that could save their life. The best treatment, and the one prone to the worst compliance, is more exercise and a better diet. Such treatment helps every system in the body in unimaginable ways. But who wants to do that? Certainly not someone status post decades of habitual self-abandon.

The point of this post-call tirade is guilty acknowledgment that I'm non-compliant. For decades I've known that the best prescription listed in the scriptures for temptation is to pray. It's repeated more often than any other commandment, according to one of my seminary teachers. Pray that you may come off conqueror, Christ tells us. Why don't I pray more, I wonder? Is it so difficult? It's even easier than flipping open the scriptures and taking in a few verses... another prescription I've left unfilled for so long. Praying and reading scriptures are the spiritual equivalent of diet and exercise--fundamental and irreplaceable.

The risk factors of ignoring God's treatment suggestions are well established in the literature. They're beyond doubt. Why then am I so poorly compliant? I should be listening to the greatest healer of all. The message is like the one I gave Mr. X, "If you ignore the treatment we're offering, if you don't follow the advice, I can't stop you. You can leave here and behave however you'd like, as you say. But you know the results of those decisions now, and it's up to you what kind of future you have."

8 comments:

Ben said...

Wow, you really mean business with this not-swearing thing. :)

-L- said...

Ben, there you go cluttering my !@#$ comments again!

Yup. My posts have gotten preachier since then too. You think there's a correlation?

Samantha said...

I love preachy blogs.

Sully said...

-L-, I really enjoyed this. It's quite true. We've been given a rather simple diet and prescription from God, but I, too, struggle with always complying. It's very interesting. Thanks for sharing your medical understanding.

Rebecca said...

You were WAY nicer than I would have been. This would have been me:

Fine. Check yourself out. Because guess what? I don't know you and I don't give a ******* flying **** if you drop dead, which, FYI, you will.

It is for sure a good thing that you're the physician, and I'm the nanny (because my mad people skillz totally come in handy with the kiddie set). So good luck with the praying thing, and with the lame--- patients.

-L- said...

Rebecca, if you ever want to go into health care, you should look me up.

Rebecca said...

You have NO IDEA. I've wanted to be a physician, off and on, since I was, um, born. The first Christmas present I remember getting (when I was 3, I think) was a doctor kit. But I'm totally lazy, and at this age the whole process looks REALLY long. So I just watch "Grey's Anatomy" and try to remember that I'd have to take PHYSICS to go to medical school. And physics? Almost as bad as having to SEE PEOPLE VOMIT.

mandi said...

"Pray out the Gay" is the term my gay husband and I use when discussing the advice he gets from anyone he turns to for help. My husband has fasted, prayed, attended the temple, studied his scriptures, and fulfilled his callings diligently for years and years. There is absolutely no guarantee that those things will keep you from temptation. More than once he has had an incredibly spiritual study period and then gone out to run and "met up" with a guy and "messed up." We both are frustrated at this over simplified answer to his struggles. Yes, those things tend to give us armor against temptation, but more often than not it has given him a false sense of security. I know that my opinion will be against what many of you believe, but this is the reality that I am coming to terms with.