Are You A Compliant Patient?

Last updated: August 2019

Today I want to talk about compliance. So, what is compliance? How can it benefit you?

What is compliance?

By definition, it’s when you comply with an order. In our case, it’s complying with a doctor’s order. Your doctor prescribes a medicine. A prescription is written. The dose and frequency is written on the prescription. The expectation is that you’re going to obey the order. The expectation is you’re going to take that medicine exactly as prescribed.

And doctors can order nonmedical stuff too. For COPD, it may include BiPAP. Your doctor may diagnose you with sleep apnea. Or, your doctor may think BiPAP may benefit your COPD. And, there is good evidence to support this belief. Studies show BiPAP may benefit COPD even in the early stages.

So, your doctor writes an order. That order is for nighttime BiPAP. The expectation by your doctor is you’re going to comply with this order. The expectation is you’re going to take your medicine every day exactly as prescribed.

Are you a compliant COPD patient?

I see this all the time in the hospital. I see people with a really bad COPD flare-up. The doctor comes in and sees the patient. The doctor diagnoses and writes orders.

And the patient is so short of breath. She will do anything to feel better. So, when the doctor orders an IV, she allows it to be put in. When the doctor orders systemic corticosteroids, she allows the nurse to put it into the IV. When the doctor orders a BiPAP, the patient allows me to put that BiPAP mask on her face.

Then the patient gets better. And she starts refusing things. Seriously! I see this all the time. And the patient is better now. She is breathing much better. And she is discharged. And a week later that same person is in the ER again. By now I know her well. I greet her by name. She smiles and greets me by name. We are friends.

We go through the same rigmarole: IV, systemic corticosteroids, BiPAP. She gets better. And then we chum like old friends. And we talk about nonmedical topics. And we talk about living with chronic lung diseases.

I learn that she has BiPAP ordered for home. And she confesses that she hasn’t been wearing it. I educate her about her COPD. I tell her about all the studies showing how well BiPAP works for COPD. I talk to her about how just wearing it at night can make breathing easier during the day.

That’s what it comes down to. I mean, you may still have flare-ups. You may still have trouble with your COPD. But, being compliant can make it so much better. It can make it so you have fewer flare-ups. It can make flare-ups less severe when they do occur. It can make your life so much better.

As a kid, I wasn't compliant

I know it’s not easy having a chronic lung disease. I have asthma. I have had terms like severe asthma and COPD discussed at times. I mean, that’s how bad my asthma can be. As a kid, I was horrible at compliance. I would have bad attacks. Then it would get better. And I’d decide I didn’t need medicine anymore. I would forget. I would get lazy. Or whatever my excuse was. And all this resulted in was more ER visits.

This got so bad that I was admitted to National Jewish in Denver. I ended up being admitted there for six months. So, it was there I learned how serious my asthma was. I learned how important it is to stay compliant. It’s allowed me to gain an iota of control of my asthma. I still have asthma episodes. But, they are much less severe because I am compliant with my doctor’s orders. I am able to live a normal life because I’m compliant.

I know COPD is a lot harder than asthma. I don’t have to wear oxygen every day. I don’t have to wear BiPAP. I know those things are hard to get used to, especially the BiPAP. But you can do it. You can get used to it. I have had patients hate it when I first try it on them. But, a month later, I will ask them how they are doing, and they say things like, “It has me feeling so much better. I would never sleep without my BiPAP again.”

It may be hard to make changes to become compliant.

It is hard to get used to taking medicine every day. It’s hard to get used to being attached to an oxygen hose. It’s hard getting used to wearing a machine over your face. But, if that’s what your doctor thinks will help you, it’s important that you give it the old college try. It’s important that you be compliant. You can do it! And that’s my lecture for today. Thoughts?

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