Re: FW: [HC] Non-compliance

[Guest guest]

good   stuff thanks

 

This is a thread about what compliance means for patients and physicians. It comes from the Community Health Center listserve. Although some of their paradigms are different than ours I thought it was worth sharing with this group. Feel free to agree or disagree.

 Personally I have always felt uncomfortable with the concept of non-compliance. I never document it in my patients as such and think that it reflects my inability to come up with a plan that makes sense in the life of my patient. Of course, if this is not the case I would be labeled as non-compliant myself (as a patient not as a physician).

 As I said, I thought it was a good thread and wanted to share with this group of committed people

  Izquierdo-Porrera MD PhD

Executive Director & Co-founderCare for Your Health, Inc

Phone  

From: Izquierdo

Sent: Friday, July 29, 2011 5:41 PMTo: Izquierdo-PorreraSubject: Fwd: [HC] Non-compliance 

 ---------- Forwarded message ----------Date: Fri, Jul 29, 2011 at 10:49 AM

Subject: Re: [HC] Non-complianceTo: HC@...The “non-compliance” issue has become rhetorical for me. That is, as a psychologist doing psychotherapy for a good 30+ years, there have been countless times patients have been “non-compliant” in every conceivable way. I learned early on that such behavior, among others, is precisely why they sought therapy in the first place. I believe it is ethically unjust to discharge someone from care for behaving symptomatically. In the vocabulary of “motivational interviewing,” I use the “non-compliance” to develop the discrepancy between what the person says s/he wants versus what s/he actually gets.

 That’s my two-cents’ worth. I commend the discussion group contributors for commenting on universal issues of great concern and interest to us all.

 ______________________________________________

Kind Regards, Bachman, PhD

Behavioral Health Services DirectorEl Dorado  Community Health Center and Placerville Health & Wellness Center

Phone: 530:621-7367 Fax: 530:622-8436Email: jbachman@...

                         

[Guest guest]

What if pt is demented or has other "psychiatric" issues, and doesn't follow up?

Do you go to their houses?

Re: [HC] Non-complianceTo: HC@...

The “non-compliance” issue has become rhetorical for me. That is, as a psychologist doing psychotherapy for a good 30+ years, there have been countless times patients have been “non-compliant” in every conceivable way. I learned early on that such behavior, among others, is precisely why they sought therapy in the first place. I believe it is ethically unjust to discharge someone from care for behaving symptomatically. In the vocabulary of “motivational interviewing,” I use the “non-compliance” to develop the discrepancy between what the person says s/he wants versus what s/he actually gets.

That’s my two-cents’ worth. I commend the discussion group contributors for commenting on universal issues of great concern and interest to us all.

______________________________________________

Kind Regards,

Bachman, PhD

Behavioral Health Services Director

El Dorado Community Health Center and Placerville Health & Wellness Center

Phone: 530:621-7367 Fax: 530:622-8436

Email: jbachman@...

[Guest guest]

In some cases I do. Most of the time I engage the family to come up with a plan that makes sense for them. I suppose given I have a majority of Latino patients it is easier because the family is an important aspect of their health discussions. I once had a demented patient that lived in Florida and would come to DC every 3 to 4 months to see me. (Honestly, don’t ask me why, there are millions of geriatricians in Florida). It was hard for me to create a meaningful relationship but I worked a lot with her daughter to come up with a plan that made sense for them. (By the way I am IM/Geriatrician so a big chunk of my patients are demented) Psychiatric ones are more difficult to deal with, you are right. Specially in Latino populations for whom mental issues are a major stigma. The harder it is for them to take the medication or follow through the more often I have them back and discuss it further. I am not successful always but at least I can catch it when things are getting worse and can do something about it. I know my approach makes people uncomfortable but most of my patients seem happy with it and my quality indicators don’t suck. Just my thoughts! Izquierdo-Porrera MD PhDExecutive Director & Co-founderCare for Your Health, IncPhone From: [mailto: ] On Behalf Of Dr LevinSent: Saturday, July 30, 2011 7:07 PMTo: Subject: Re: FW: [HC] Non-compliance What if pt is demented or has other " psychiatric " issues, and doesn't follow up? Do you go to their houses? Re: [HC] Non-complianceTo: HC@...The “non-compliance” issue has become rhetorical for me. That is, as a psychologist doing psychotherapy for a good 30+ years, there have been countless times patients have been “non-compliant” in every conceivable way. I learned early on that such behavior, among others, is precisely why they sought therapy in the first place. I believe it is ethically unjust to discharge someone from care for behaving symptomatically. In the vocabulary of “motivational interviewing,” I use the “non-compliance” to develop the discrepancy between what the person says s/he wants versus what s/he actually gets. That’s my two-cents’ worth. I commend the discussion group contributors for commenting on universal issues of great concern and interest to us all.______________________________________________Kind Regards, Bachman, PhDBehavioral Health Services DirectorEl Dorado Community Health Center and Placerville Health & Wellness CenterPhone: 530:621-7367 Fax: 530:622-8436Email: jbachman@...

[Guest guest]

The most useful thing I  ever heard about this topic was the idea  that if you take your money to a financial guy and you have $250.00 they  advise you how to manage your finances.   If you go to the same guy with 5,000 or 5 million they advise you how to manage it They walk along with you no mater what your level no matter where you are in the spectrum of things. Nothing I learned in medical school made that much sense to me

IN med school I got the psychology and the anatomy and physiology I think I have long lost,  the " be patietn centered " without telling me what that meant,  but I never " got permission " to walk with the patient becasue I was still supposed to get that damned Hgb A1c every 3months

Whici is  why I would rather measure    access and ER use and re admits and cost and patietn quality of life and work on   med reconciliation and care coordination  and expanding skills to keep them with one doc, ( whicih s why they come see MAria  I bet,  I hear Florida is crazy full of   fragmenting specialists) it is so much more interesting and useful.Though cognitively I am exhausted.

I know as the doc to watch for and advise the  dm care the lpids the   beta blockers  but I walk along with differnt folks at their level and this works.

 

In some cases I do. Most of the time I engage the family to come up with a plan that makes sense for them. I suppose given I have a majority of Latino patients it is easier because the family is an important aspect of their health discussions. I once had a demented patient that lived in Florida and would come to DC every 3 to 4 months to see me. (Honestly, don’t ask me why, there are millions of geriatricians in Florida). It was hard for me to create a meaningful relationship but I worked a lot with her daughter to come up with a plan that made sense for them. (By the way I am IM/Geriatrician so a big chunk of my patients are demented)

 Psychiatric ones are more difficult to deal with, you are right. Specially in Latino populations for whom mental issues are a major stigma. The harder it is for them to take the medication or follow through the more often I have them back and discuss it further. I am not successful always but at least I can catch it when things are getting worse and can do something about it.

 I know my approach makes people uncomfortable but most of my patients seem happy with it and my quality indicators don’t suck. Just my thoughts!

  Izquierdo-Porrera MD PhD

Executive Director & Co-founderCare for Your Health, Inc

Phone  

From: [mailto: ] On Behalf Of Dr Levin

Sent: Saturday, July 30, 2011 7:07 PMTo: Subject: Re: FW: [HC] Non-compliance

   What if pt is demented or has other " psychiatric " issues, and doesn't follow up?

 Do you go to their houses?

Re: [HC] Non-complianceTo: HC@...

The “non-compliance” issue has become rhetorical for me. That is, as a psychologist doing psychotherapy for a good 30+ years, there have been countless times patients have been “non-compliant” in every conceivable way. I learned early on that such behavior, among others, is precisely why they sought therapy in the first place. I believe it is ethically unjust to discharge someone from care for behaving symptomatically. In the vocabulary of “motivational interviewing,” I use the “non-compliance” to develop the discrepancy between what the person says s/he wants versus what s/he actually gets.

That’s my two-cents’ worth. I commend the discussion group contributors for commenting on universal issues of great concern and interest to us all.

______________________________________________Kind Regards,

Bachman, PhDBehavioral Health Services Director

El Dorado  Community Health Center and Placerville Health & Wellness CenterPhone: 530:621-7367 Fax: 530:622-8436

Email: jbachman@...                         

[Guest guest]

It's not your approach, just eventually you have to realize, just like in the "House of God" book by Shem (look it up, you're an IM and I'm sure you'll get a kick out of it),

You are not the pt.

Sometimes YOU cannot fix the pt's problems and have to let them go.

I don't do it alot, but sometimes I do it OR the pt finally does it on their own. Many pts just canNOT come back more often or refuse.

Just my thoughts...maybe 25 years of practice are getting to me? :-)

Matt in Western PA

FP since 1988

Solo since 2004

Re: [HC] Non-complianceTo: HC@...

The “non-compliance” issue has become rhetorical for me. That is, as a psychologist doing psychotherapy for a good 30+ years, there have been countless times patients have been “non-compliant” in every conceivable way. I learned early on that such behavior, among others, is precisely why they sought therapy in the first place. I believe it is ethically unjust to discharge someone from care for behaving symptomatically. In the vocabulary of “motivational interviewing,” I use the “non-compliance” to develop the discrepancy between what the person says s/he wants versus what s/he actually gets.

That’s my two-cents’ worth. I commend the discussion group contributors for commenting on universal issues of great concern and interest to us all.

______________________________________________

Kind Regards,

Bachman, PhD

Behavioral Health Services Director

El Dorado Community Health Center and Placerville Health & Wellness Center

Phone: 530:621-7367 Fax: 530:622-8436

Email: jbachman@...

[Guest guest]

It may be that I go into the relationship with my patient with somewhat of a different expectation. I am a geriatrician first and foremost, so early on in my training I realized I could not fix most of my patient’s problems. So I go into it with the idea to be around and help in whatever way I can. I have discussed this approach with some of my IM colleagues and they feel uncomfortable with the idea that we are not there to fix stuff. I know I sound naïve but I have been in practice for 12 years and this approach works for me. Having said that I am not opposed to dismissing patients from a practice if the relationship is not working for either or both. I just have not felt the need to do it to date. Who knows tomorrow! Izquierdo-Porrera MD PhDExecutive Director & Co-founderCare for Your Health, IncPhone From: [mailto: ] On Behalf Of Dr LevinSent: Sunday, July 31, 2011 9:01 PMTo: Subject: Re: FW: [HC] Non-compliance It's not your approach, just eventually you have to realize, just like in the " House of God " book by Shem (look it up, you're an IM and I'm sure you'll get a kick out of it), You are not the pt.Sometimes YOU cannot fix the pt's problems and have to let them go. I don't do it alot, but sometimes I do it OR the pt finally does it on their own. Many pts just canNOT come back more often or refuse. Just my thoughts...maybe 25 years of practice are getting to me? :-) Matt in Western PAFP since 1988Solo since 2004 Re: [HC] Non-complianceTo: HC@...The “non-compliance” issue has become rhetorical for me. That is, as a psychologist doing psychotherapy for a good 30+ years, there have been countless times patients have been “non-compliant” in every conceivable way. I learned early on that such behavior, among others, is precisely why they sought therapy in the first place. I believe it is ethically unjust to discharge someone from care for behaving symptomatically. In the vocabulary of “motivational interviewing,” I use the “non-compliance” to develop the discrepancy between what the person says s/he wants versus what s/he actually gets. That’s my two-cents’ worth. I commend the discussion group contributors for commenting on universal issues of great concern and interest to us all.______________________________________________Kind Regards, Bachman, PhDBehavioral Health Services DirectorEl Dorado Community Health Center and Placerville Health & Wellness CenterPhone: 530:621-7367 Fax: 530:622-8436Email: jbachman@...