Jennifer T wrote:

<< I have found that asking ahead of time whether  the patient feels they can
adhere to a particular treatment saves me a lot  of frustration.  If the
patient tells me at the start that they don't think  they can, for example, take a
medicine 4 times a day, then we have to find  another option.  Same with
pumping regimens and other behaviors.  If we are  in a situation where I feel the
plan I want is the *only* one that will  work, then I tell the patient that,
but if they choose not to follow this  plan, it is their responsibility, not
mine. >>

I agree that  explaining rationale and asking about feasiblity is important.
I also find that sometimes no matter how much we discuss something, why it
might help, how to manage it, some plans become unmanageable in the reality of
the ongoing work. Having moms "own the plan" as Jennifer said, hopefully also
means they feel comfortable in saying " I tried this but it just isn't working
for me/just can't do it,"etc. , so we can try something else, shift focus,
prioritize more limitedly if needed, change time frames, etc, and the mom has a
choice again and again so she doesn't feel that staying with a program  or
giving up are her only two options. Admittedly, it doesn't always work, but it
still seems like a good idea to build into every plan.
Judy LeVan Fram, Brooklyn, USA

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