Analogies for patients in the battle against medical noncompliance

Many patients who are noncompliant may not understand the long-term damage being done to their bodies.
Many patients who are noncompliant may not understand the long-term damage being done to their bodies.

Simple analogies could enhance medical compliance. Medical noncompliance is a large deterrence to the achievement of treatment goals. There are many reasons to explain why patients are noncompliant. Among them is the fact that patients are unaware or do not understand the negative impact that their uncontrolled chronic medical problem has on their well-being.

For instance, many times a patient who is not taking his or her blood pressure medications presents to the clinic with a high blood pressure reading. After questioning, the patient will tell his or her provider, “My blood pressure is always high,” and appear not at all concerned about it. Some will admit to not taking their medications despite knowing that their blood pressure is high. Many of the patients are unaware of the actual damage that their uncontrolled medical problems has on their bodies and specifically their end organs.

Even though limited by time constraints, some healthcare providers are able to educate their patients on the negative impact of uncontrolled chronic medical problems. The problem that may arise though is whether the patient understands this information. For example, when a provider tells a patient that high blood pressure damages the kidneys, does the patient understand how this occurs? Some patients may become more compliant with their treatment if they understood this information and it was provided at a very simple and easy to understand level. Alternatively, using simple analogies may be beneficial in ensuring that understanding. It would be important, however, to make the patient aware that the actual occurrence in the body is more complicated than the analogy used.

For uncontrolled blood pressure, for instance, an analogy a provider could use is that of comparing the cardiovascular system to a city water system, with the heart being one main water pump just as in a city water system. If the pressure within the city water system piping became elevated, it would be likely for one of the pipes to break or burst. The pipe that would be most likely to burst would be the weakest. Relating that to the human body, high pressures within the blood vessels would put the weakest/smallest vessels at risk of a burst or a break. Further elaborating, these weakest blood vessels are in the human brain, in the kidneys, in the eyes, and in the heart. If the break or burst occurred in the brain, that would be a hemorrhagic stroke. In the kidneys and in the eyes, these high pressures cause micro-aneurysms or even small bursts that are not visible to the patient. Due to the lack of an outward manifestation, the patient may be unaware of the breaks/bursts until extensive damage has been done to the organ for long periods of time.

Similarly, in uncontrolled diabetes, analogies relating to the microvascular and macrovascular complications would be of benefit—for example, a simple analogy of a clogged water pipe due to rust and other accumulation inside the pipe that deters free flow of water. Similarly, accumulation of plaque in the blood vessels caused by uncontrolled blood glucose and other factors deters the flow of blood to the intended areas such as in the muscles of the heart, the distal parts of extremities, and others areas leading to issues that include heart attacks and peripheral vascular disease that can lead to loss of limb.

Compliance with medical treatment takes a lot of effort on the part of the patient and the provider, and many factors determine the success of these efforts. Analogies could be a small part of this large effort to enhance compliance. Every area of practice could have applicable analogies.—SAM MBUGUA, MSN, FNP-C, Arlington, Texas. (206-3)


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