I was reminded of the illusion of choice the other day. My father-in-law was deciding on dinner from the “soft foods” available on the hospital menu. I was surprised at how many tasty sounding options he had, even if he was restricted to soft foods. While he agreed he had more options than you might think, what he really craved was a salad.
It brought to mind getting my then six-year old daughter dressed for school in the morning in a timely manner because it also involved the illusion of choice. The night before we would select two outfits and the next morning she could choose one of them. It was simple, straightforward and it worked, until … the day she refused to accept that there were only two choices available.
See, the illusion of choice only works when we accept that we will choose from the options presented. In my father-in-law’s case, he felt he had no choice so he will stick to the soft foods for another couple days. The alternative would be detrimental to his health and he accepts that reality. The day my daughter realized she had an entire closet of options, she demanded to know why she had to limit herself. And, really, that is the question: why do we impose limits, when should we simply accept this is good for us, and when do we push back?
Let’s apply this to a treatment plan or more specifically to medication that has been prescribed to treat an illness. While we may be presented with more than one option, generally physicians have a “go-to” drug to treat a particular ailment (when medication is warranted). As patients, we are often so relieved to be diagnosed and know we can be treated with medication, we go along with it and wait eagerly for relief from the symptoms of our disease.
Here’s a question: how many people read the warning labels on their medication? I’m not talking about just on the bottle, but the multiple pages pharmacists hand out. As I’m sure most of us have, suffice it to say these scare the beejeepers out of me and that’s saying something considering the medications I take regularly.
I know, I know. The drug companies have to list all the possible side-effects even if the odds we experience them are minsicule. Ignore for a moment the risk of stroke, paralysis, or other nasty side-effects and consider the ones that sound innocuous enough like dry mouth, headache, and upset stomach.
From experience, I can tell you that after months of not having a flare-up (of inflammation), I desperately want to get rid of these “minor” side-effects because I will have forgotten how bad it was before. And that’s when we begin to run into compliance issues.
I started with a discussion about illusion of choice so let me get back to it with this: when a patient feels the side-effects are at least as bad as the original ailment, they begin to waver in their commitment to comply with doctor’s orders. Let’s not forget that taking medications are also inconvenient and expensive (especially for those without a drug plan).
Not saying it’s right, just saying it happens. We begin to wonder if there are other options. Sometimes, instead of asking our doctor, we take it upon ourselves to determine what options are available and that is when we run into trouble. Whereas my daughter was checking out her entire closet for options, patients have google.
So what’s the point to all this?
There’s a natural progression that patients go through in their treatment plan. If you recall, my father-in-law decided the soft foods restriction was worth following and it wasn’t going to last forever. Not only that, this treatment was not ambiguous or subject to the individual’s case: you have abdominal surgery, you have restricted diet. Period.
It’s when a patient has a chronic treatment plan that things get a little messy. There is no end to the treatment. There is no single way forward because everyone reacts a little differently to medications. Just like my daughter who wouldn’t accept a two option restriction – take it or leave it – patients in a treatment plan for the long haul will push back and that can be viewed as a problem or an opportunity for greater compliance.
Remember: the underlying premise is that we all want a patient to get better, but what “better” means for one party may be different for the other. We all reach a point when we can’t just tell a person the way it has to be “for their own good”. The illusion of choice works well for a long time, but when a patient starts pushing back, you have to be prepared to change the options to ones that the patient accepts for themselves … and then support them in those choices.
The alternative will always be non-compliance.