Or more precisely, why do some patients not follow their doctors’ orders even when it is blindingly obvious that they should do so? In Monday’s NY Times there was an interesting article about patients who are being paid to take their medicine in a reliable manner. I was going to write about the payment issue as it raises all sorts of questions, but I’ve become fixated on something in the article: ignoring obvious incentives to take care of yourself.
For example, once a juvenile diabetic (someone who can’t manufacture his or her own insulin) takes a lot of insulin before eating a meal, there are relatively quick and immediate consequences from not eating food shortly thereafter: dizziness, followed by incoherence and disorientation, unconsciousness, and, if still not dealt with, brain damage. This tends to focus one’s attention. On the other hand, consider something like dental hygiene. If you miss flossing once in a while, your teeth won’t immediately fall out of your head. But if you don’t take regular care of your teeth, eventually they will fall out of your head*. In this case, there isn’t an immediate link between poor behavior and poor health, which can lead to the occasional bout of harmful behavior.
Which leads me to the part of the NY Times story that I’m hung up on (italics mine):
Before the program, Chiquita Parker, a 25-year-old single mother with lupus, too ill to continue her job with special needs children, repeatedly made medication mistakes, although she knows she depends on warfarin to prevent clots than can cause strokes, paralysis, or death.
“I would forget to take it,” and feel “like I couldn’t breathe,” she said. Or she would “take two in a day,” and develop bruises from uncontrolled internal bleeding.
But in the six-month lottery program, she pocketed about $300. “You got something for taking it,” Ms. Parker said. Suddenly, she said, “I was taking it regularly, I was doing so good.”
…”I really went backward,” Ms. Parker said, after her participation ended. “I’m just forgetting all over again.”
I don’t get this. How do you forget to take medication, when, if you don’t, you have difficultly breathing? I would make that an essential part of my day. And the feedback loop here is pretty direct–this isn’t a case of if you don’t take the warfarin for an entire month, bad things happen. I don’t mean to pick on this person at all (I don’t wish lupus on anyone), but I’m having a really hard time understanding this. There’s no mention of side effects in this person’s case (and if there were, they didn’t seem to interfere when money was involved).
So my questions for healthcare providers and public health people are:
1) Is this failure to take medication with relatively proximate consequences common?
2) Do you have any idea why people do this?
*By the way, when is ScienceBlogs getting a toothyologist? Just asking.