Compliance with a medication regime whatever your condition is a really hard task to master. Anyone who says they always take their medication and never forget or skip doses is lying to themselves. We all miss doses here and there for a huge number of both legitimate reasons and those not so legitimate. I can be honest and say I have not always taken all my medication for a really wide variety of reasons. Here are just a few:
1) I just don’t see the point- they don’t seem to be making me better or giving me a better quality of life so why keep taking something that is giving me a huge number of side effects for little actual benefit.
2) Just can’t be bothered
3&4) At university sometimes at night out meant I was drunk going to bed so didnt take my medication because getting to bed was top priority and then in the morning being too hungover and feeling sick so no medication gets taken then either!!
5) Not having time to go and get prescriptions
6) Rebelling and not having the choice
7) Food poisoning or stomach bugs make taking medication hard
8) Having things like oral thrush give you a really sore mouth
9) Poor understanding of what the medication does
10) Fear of the side effects
But compliance is not just about taking medication or not. Automatically if a Dr or medical professional mentions the word compliance we as patients think medication but I have recently realised its not all about the pharmaceutical side of things.
After a conversation I had with a researcher when I was in Oxford who is interested in compliance in teenagers with asthma, I almost automatically got on my soap box and gave my opinion that teenagers are just not programmed to comply. If you tell them to do one thing they will probably do the opposite and its not just medication but everything in life. I was so focused on the medication side of things that I didnt actually think that compliance is so much more than taking your prescribed inhaler or tablets at the right time. I have come to realise that it is about having a full understanding of your condition. Sticking to your mediation regime is just a small part of it. You need to acknowledge when you are getting worse and take action to prevent hospital admissions or visits to the Dr’s. You need to be prepared incase you get a cold then you can adapt and stay well. If you know you are coming up to a stressful time and your condition is exacerbated by stress then you may need more medication to help get through it, or even if you are going on holiday or having a big night out that may make your condition worse you may need some preplanning to make sure you get through it all with out any negative consequences.
It is very easy to say that because I have X, Y or Z then I can’t do something but just because you have a medical illness it does not mean you can’t do things but pre-meds may be needed, or time after to rest and recuperate may need to be scheduled.
I have realised that compliance is about yourself as a hole and knowing what triggers your symptoms and makes you condition worse. We cannot go around life by not part taking in things because we may get ill, we just need to be prepared for eventualities which may happen as a result and have everything in place, not feel sorry for yourself after because you have done something you condition has got worse and your now sitting thinking why me. It is crap but these are the cards we are dealt sometimes and feeling sorry for ones self is not the way to go about it. We can feel sorry for ourselves and down in the dumps if we had taken all the actions we could and we still end up in a bad way.
Compliance is more about education than just taking the medication when we are meant to. I do not think there is a patient out there who can honestly say they have taken their medication everyday when they are meant to and never missed a dose.
My personal story about compliance I reckon a lot of people could relate to. Looking back now at some of the things I used to do make me shiver with fear and wonder at how I am still alive and able to do as I can. I used to do so many stupid things. I did take all my medications when I should, I hated the side effects. I also so badly wanted to play sport but was on a syringe driver- my answer was just to bolus a bit, disconnect myself, play sport, and reconnect (normally having collapsed on the pitch). I didnt always take my nebs because they took up too much time and I had an excuse for everything. A lot of it was denial. I didnt want brittle asthma, I didnt want asthma. I wanted freedom and wanted normality and to be a student like all the others. I did everything I could to get way from it and in actual fact everything I did made sure it was ever more present in my life than it needed to be had I just acknowledged it understood my asthma more. Had I done that I would probably have enjoyed university a lot more and been a lot healthier now.
As I have grown up and defiantly since doing my Nursing I do feel I comply. I try to be as well as I can be. I take precautions and plan my days and have spare meds incase of mishaps. I don’t fully comply still but have told my Dr this. He wanted me on QDS nebs but as my nebs are short acting beta agonists if I am feeling ok I don’t do them four times a day. I will always do them at least twice but by being honest we have a better working relationship and he trusts my judgement. This trust has given me more confidence in managing my asthma which still feels like a really tall order but I know I am doing the right things.
I hope more people understand just how important it is to comply not just with medications but your overall condition.