‘Non-compliance’ as illness management: Hemodialysis patients’ descriptions of a

[natnnnat]

‘Non-compliance’ as illness management: Hemodialysis patients’ descriptions of adversarial patient–clinician interactions

Allen, D., Wainwright, M. & Hutchinson, T. 2011, ''Non-compliance' as illness management: Hemodialysis patients' descriptions of adversarial patient-clinician interactions', Social Science & Medicine, vol. 73, no. 1, pp. 129-134.

Highlights: 
► “Assembly line” treatment and disregard for patient knowledge contributed to hemodialysis patient–clinician tension.
► Patients distrusted clinicians who did not respect them as uniquely knowledgeable about their body, illness, and life.
► Patients viewed adversarial interactions with clinicians as an unfortunate but necessary feature of illness management.

With only 50% of patients in developed countries following the therapies prescribed for them by health professionals, “non-compliance” is commonly described as causing increases in morbidity, hospital visits, and overall healthcare costs. A plethora of non-compliance studies have failed to identify consistent predictors for, or solutions to, patients’ non-compliance. Our longitudinal (September 2006–September 2008) participatory action research (PAR) focused on (a) understanding hemodialysis patients’ perspectives on the challenges and solutions to living well with their chronic illness and (b) taking action to improve this population’s quality of life. The study’s participants included seven purposefully sampled patients in two hospital hemodialysis units in Canada. A small sample size was essential to accommodate our commitment to conducting a PAR study with this patient population whose unpredictable health status presented significant challenges to recruitment, follow-up interviews, and participation in data analysis. Data collection and analysis over 2 years included over 100 h of ethnographic field observation, bi-weekly unrecorded and 12 audio-recorded in-dialysis interviews, five video-recorded life-history interviews, two video-recorded focus groups, and five video-recorded dialysis treatment sessions. Thematic content analysis drew attention to patients’ descriptions of adversarial interactions with health professionals. In these interactions, three points of tension were identified: (a) between whole person care and “assembly line” treatment, (b) between patient knowledge and medical expertise, and (c) between shared decision-making and “digging to find out”. The article concludes that these adversarial relationships are indicative of a lack of trust stemming from health professionals’ failure to interact with patients as whole persons with unique expertise on their bodies, their experience of illness, and their lives.

[willowtreewren]

Frankly, I think those results would hold true for many doctor/patient interactions.

 

[MooseMom]

I agree with WTW.  I suspect that, say, a cancer patient might have the same gripes.

[cattlekid]

I for sure know that I've had gastros in the past who I've had my share of "discussions" with 

This is why I am loving my current PCP and loved my referring neph.  They understand the concept of dr. and patient working together - go figure!    

I had to train my current D neph, but she's getting it.   

[MooseMom]

I suspect that some docs have an ego the size of a small planet, and they see a knowledgeable patient as a professional threat.  Other doctors really enjoy having a patient who is engaged and well-educated.  Which one you get is just a matter of luck.

[willowtreewren]

Yeah. I nearly loved my PCP, but then she went on sabbatical! 

She would lay out options for me with pros and cons, but never "pushed" for a particular choice. Plus, she just plain listened.

I'll meet my "new" guy Thursday in what was supposed to be my annual physical, but will now be my "new patient in-take" meeting. ARGH! I swear, even if I like him, I'm going back to my other doctor as soon as she finishes her sabbatical! 

Aleta