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I know what to do, yet I don’t

Or why do Patients not comply with their Care Directives. Is it a case of being penny wise pound foolish? Sort of.

As patients, we know what we need to do, but we don’t. We seem to neglect some very important aspects of our health. Like eating right. Exercising regularly. Taking rest. Taking medication. Sticking to the care plan. Very often it does not cost anything extra to follow these Directives. Then why don’t we do these ‘things’? Or is it something else?

It was very clear from my study of published research that non-clinical aspects of our care have a huge role to play in outcomes. I have talked about it in my earlier blogs in the Determinants of Health.

But that was published research. I decided to check this out for myself.

I thought the best way would be to go to the source and get it from the horse’s mouth. Get first-hand information – from the stakeholders in our health – Us – the Patients, our Caregivers, Doctors, Nurses, and Frontline workers. I have spoken to over 500 people in the past 5 or 6 years.

This blog, and what I will write in subsequent blogs comes mainly  from these interviews, from talking to patients – people like you and me. What I found was revealing, but obvious and not surprising. It is ‘stuff’ that we all know but do not really think about ‘actively’.

I heard from Care Providers that in general patients know what to do, yet they don’t, i.e. they don’t stick to their Care Plan!

Not quite. It may seem like that on the surface, but what emerged from these discussions is that it is not that patients do not want to comply with their ‘Care Directives’, they find it difficult to comply with them.

Broadly speaking, there are two reasons why patients are not able to keep up with their Care Directives.

The first is that patients find it difficult to comply with their care directives for a variety of reasons. For example, there could be issues of Comprehension – patients do not really understand the care directives properly; Physical Ability – when patients are unwell, they are not really at their best and may not be able to do things required of them; Financial – Patients may not have the financial resources to do what is  required of them.

The second are patients that start off well. Patients that are on top of their Care Directives to start with. They do what they are supposed to do. Once their health improves a bit, the more bothersome symptoms of their conditions recede, their health condition ceases to be a cause for immediate concern. This leads them to ease up on the rigor with which they follow their Care Directives. They ‘fall off the wagon’.

At times it could be a combination of the two categories.

Let’s take Nutrition, an important aspect of most Care Directives. Why can’t one stick to something as simple as a diet plan? Maintain a Nutritional regime that they are supposed to maintain.

We asked that question.

We found that some folks may not have the help, support or wherewithal to eat the kind of food they are supposed eat, maintain the diet they are supposed to – the first category that I mention earlier in this post. This could be for a variety of reasons; logistical – they may not have someone who can go to a grocery store regularly to shop for them; or comprehension – they may not know if a particular food is ok for them to eat in their condition; or understanding – they may unknowingly end up maintaining a diet thinking that is what they are supposed to be doing.

And then there is the second category of patients. They start off well. They stick to their Nutrition regime they are supposed to maintain. They eat the stuff they are supposed to eat and generally do the things they are supposed to do. However, once the more bothersome symptoms fade, they ‘fall off the wagon’. They fail to stick to the diet plan. We encountered more than a few instances of – “I may have diabetes, but what does a soda now and then matter, or a little more salt”.

Relatable, right? 🙂 And even more significantly, patients understand that if they do not comply with their Care Directives not only will it harm their health, it will also cost them more money in getting more care.

We found that patients are divided almost equally in these two categories.

The next question was to ask patients how this could be addressed. What could be done to “keep them on the wagon”? What could help them be truer to their Care Directives than they generally are?

There was no single answer. But like I said earlier, some of the answers were hiding in plain sight.

I will talk about them in my next blog.

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