Be disciplined . . . And get better results!

Non-compliance, indiscipline, nonconformity, whatever you want to call it – works for no one! Within each work week, we see a number of clients who do not follow the seemingly simple instructions that are given to them. Treating non-compliant clients, especially those with more severe issues, can be very challenging.

Let’s look at a scenario. Mr. & Mrs. John Smith (names changed), come in to check on a 2 year old problem of toe-nail infection that Mr. Smith has. Almost ALL the nails are black and he tells me that he tried things before but it “eh wukkin.” Of course I questioned him about what was used, and how compliant he was, given the particular ailment. Mrs. Smith starts to roll her eyes and exclaims “m’am to tell yuh d truth, he does do ting when he want, so dat is part of d problem!”

When I use the term non-compliant, I am sure that persons in the industry immediately can visualise their most memorable client. You may refer to this client as problematic and stubborn, but don’t these negative judgments of clients make these challenging cases appear even more frustrating? After all, non-compliance ultimately causes delays in the resolution of problems, and often leads to more aggressive and costly treatments.

It’s important, therefore, to strive for a better understanding of the indisciplined client. Indeed, non-compliance is defined as the lack of follow through with advice. However, non-compliance can also be the intentional result of a rational decision, based on personal beliefs related to the ailment, and its treatment. In other words, does the client own his/ her complications, or is he/she in a state of denial?

Because the term compliance has a negative connotation, people who have researched it generally prefer to use the term adherence. Several key factors are linked to non-compliance, including social and family relationships, experiences with the health care system, and client perceptions about ailment and treatment options/products.

Understanding Non-Compliance Factors

In trying to come to terms with this behaviour, it has been found that the client may be the true source of non-compliance. To be able to resolve it, there are several key questions that must be asked.

• Is the client assuming control over the problem/s?

• Has the client been educated about the outcomes?

• What is the client’s attitude toward the ailment?

The answers to these difficult questions may reveal the reasons why instructions are not being followed. Of course, obtaining the answers could be a difficult process given the number of clients one may see in a given day.

Other client factors influencing compliance are impaired mobility, cost (treatment options/products), fear, pride, and the client’s perception of whether he or she is feeling better, worse or, feels there is a lack of progress.
There are also factors associated with the fact that clients may have tried other failed treatment options/products. With the elderly, having to depend on relatives, or pay high prices for hired transport are some of the critical issues.

What Should Be Done To Boost Compliance

Sometimes unknowingly, you play a role in patient non-compliance as well. It’s important to evaluate your own attitude toward clients. The client should feel that you are truly concerned about them, which you are, and not that they are just the next case. Clients respond best when there is continuity of care and consistent follow-through.

Most people are already squeezed for time with busy schedules; so that non-compliance can often be the result of poor understanding, and rigidly structured regimes that the client will just simply give up. If you want to influence patient compliance, consider the following keys:

• Explain the logic behind your therapeutic advice.

• Understand client concerns about the effectiveness of treatment options/products.

• Talk about the client’s problems regarding continuation of care.

• Determine if treatments may interfere with the client’s lifestyle (type of footwear used/work schedule).

• Include the client’s family/significant other, once present, in your education efforts.

• Provide pre-printed handouts with instructions.

• Be specific.

Empowering Clients

Clearly, if you want a client to be compliant with a particular regimen, a high level of education is required. The empowerment approach is a favoured one. At our Clinic we provide all the necessary information, and clients can make the best decision for themselves based on their own needs, circumstances and expectations. In this regard, clients accept responsibilities and experience their own consequences.

With regard to adolescents and seniors, the most powerful source of compliance is support. One must establish a regime, and getting assistance from family or caregivers may be necessary to ensure clients are executing the recommended treatment options and using the required products.

Missed Appointments

Missed appointments are sometimes a problem for many practitioners/service providers. Overall, missed appointment rates, especially amongst those with serious problems are high at times. There are some factors that have been linked to missed appointments. For example, clients may have a financial situation, a relative that’s ailing, a bad experience with a product or particular service personnel. It’s important that you try to follow through in order to achieve client satisfaction and compliance.

Finally, for those of you seeking professional help, I trust that you’ll use this piece as a yardstick for your healthcare/service provider, as well as to judge for yourself how compliant you are. We love microwave solutions for our ailments, except most times they didn’t happen overnight unless it was an accident. So, cooperate and ensure you get the results you deserve . . . faster, and more cost effectively overall! As well, don’t forget to communicate in the event you can’t keep an appointment; it’s not only inconsiderate by not doing so, but you may deny someone else the opportunity to benefit from the available opening.

Your feet mirror your general health . . . cherish them!

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