Just wanted to chime in on this issue of compliance.  This is a word I avoid
in my practice for many of the reasons others of you have voiced.  I try in
my practice not to give orders with which my patients do or do not comply.
Instead, we try to come up with a treatment plan together that the patient
feels they can adhere to.  As much as possible, I try to get the patient to
own the medical plan.  Then it becomes natural and non-confrontational to
ask how they are doing with the plan we came up with.
It is amazing to me that women are ever able to stick to some of the
breastfeeding management plans we come up with for them, considering that I
have a hard time getting folks to even take a simple pill 3 or 4 times a day
in other areas of medicine!  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.
Of course, I do get those patients who pretty much refuse to accept any
responsibility, for whom it will always be my fault if things don't turn out
the way they wanted.  I try to be just as careful to list my reasons for the
plan I've come up with, and elicit their cooperation.  I can sleep at night
this way, knowing that at least I tried.
Jennifer Tieman
Family Physician
Mom to 4, including nursling Caroline Rose born 5/31/03

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