heart disease

“Why aren’t you taking your cholesterol medication?”  I asked the woman.

With the coronary disease I diagnosed a year ago, my discovery that she had not taken her medication was very troubling.

“It made me tired,” she replied matter-of-factly.  ”And besides, the cardiologist said the stress test was negative, so my heart is fine!”

I ordered the stress test after her heart calcium score was significantly elevated, revealing significant atherosclerosis.  She totally misunderstood the results, and I needed to fix that problem.  So I pulled out my secret weapon: a good analogy.

“The purpose of the calcium score test was to see if you had termites in your home”  I explained.  ”I found them.  The negative stress test just said that the termites hadn’t eaten through your walls.  It’s good news that your walls aren’t falling down, but they will if we don’t stop the termites.”

Her eyes opened wide comprehension: the termites were eating her walls.  She was living on borrowed time.

“Would you take a medication if it didn’t have side effects?” I asked.

She quickly nodded.  Of course she would.  From now on she would be a compliant patient.

Compliance is good.  Noncompliance is bad.  It’s something I learned very early in my training: patients who do what their doctors say are compliant (good), and those who don’t follow instructions are noncompliant (bad).  If you are lucky as a doctor, you have compliant patients.  They are the best kind.   They obey their doctors.  They are submissive.  Noncompliant patients are bad; they are a bunch of deadbeats.

Please hold your nasty comments; I don’t really believe my patients should obey or submit to me.*

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