#253 Defining Diabetes: Non Compliant
Defining Diabetes: Non Compliant
Scott and Jenny Smith, CDE define the terms at the center of your type 1 diabetes care
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Scott Benner 0:00
Defining diabetes is made possible by Dexcom on the pod and dancing for diabetes, please remember that nothing you hear on the Juicebox Podcast should be considered advice medical or otherwise the Always consult a physician before becoming bold with insulin, or making any changes to your medical plan. Today, Jenny Smith and I will define and then break down in a little more detail, the term non compliant. We did a bunch of definitions. And they've been running Friday's just these little short episodes and people seem to be enjoying them. So far, we've we've done a lengthy time and range, Bolus bazel. Pre I think we've done Pre-Bolus honeymooning, a one C. And I was wondering, there's, there's one I want to kind of slip in here. Because I want to understand it from a clinicians point of view, this is going to be something that it's funny, I don't really think of this as a real thing. I guess I'll say what I think about that in a second. But when your doctor or a nurse or a clinician or someone they call you non compliant, from a medical perspective, what are they saying?
Jennifer Smith, CDE 1:10
Oh, that's a can of worms there,
Scott Benner 1:13
right? It's a beehive, right? But we're gonna, we're gonna pick through this, there's a tiny bit of noise behind me for the first minute or so maybe it's the beehive.
Jennifer Smith, CDE 1:23
Unfortunately, it's commonly still a term that's used as used in regard to a person who does not take a prescribed medication or follow a prescribed course of treatment that the clinician has told them to follow. That's kind of in a nutshell, that's non compliance. Now, if that's the case, as I say that every he died, he presented people with diet type one diabetes, especially, are probably non compliant. Quite honestly. And and I'm not saying that I mean, I am technically, if I were to be considered by my endo as following every rule that he told me to do, and free adjustment, I am not in compliance then. Right. Because I fortunately have I've got a good endo, who is very, you know, happy and willing to work and talk with me on an educated level, and we discuss back and forth. But non compliance comes in when the doctors like set these bezels, or they grab your pump, and they set the bezels for you, and you walk out the door and in your car, you're like, Nope, I'm gonna turn on.
Scott Benner 2:33
Because I know more than the doctor knows. Right. And so technically, you would be called non compliant, right? I it's a very bad term. It's a bad term. It's horrible. It gets hurt is trying, right? Like you're not trying, you're not wrestling. So I think there's a way to get through this. Okay, so best intentions for this just being a definitions episode, it sort of turned into a tiny conversation goes on in about five more minutes, I'm going to cut the music out of the background and let you keep listening. I think that it gets used a few different ways. I think that, that when you hear it as the patient or the parent, it sounds like it sounds like you're you're being jumped on it. And you might be because a bad endo will call you non compliant. If you're not having the results that they want you to have. They never stopped. They think that their direction may not have been very good, right? Like, you know, you told me to do this. And because you're sitting across from the gun, look, I did what you said. But it didn't work. That doesn't make me non compliant that makes what you said, non valuable. Right? Right. Like you gave me You gave me invaluable information, I followed it, I didn't get anywhere you don't know what to say next. So you call me non compliant, there is a medical term for it. For Non compliance. It just means like you said, like, you know, if a doctor tells you to take this pill, you know, every six hours and you don't do it, you're non compliant. You're not you're non compliant for the purposes of their reporting and your notes you were non compliant with with what needed to be done.
Jennifer Smith, CDE 4:08
And I think in terms of diabetes, unfortunately, the fact is that they have a set of goals that they need to check off and want to check off as far as what they've gone over. Many times I feel like they use the term non compliant because they've not physically asked what are your goals? What do you want to work on? What are you trying to achieve and manage and take care of? And if that's not addressed, then of course, you're going to look non compliant because they didn't help you with what you actually needed help with to begin with. So why should you pay attention to what they told you to do?
Scott Benner 4:43
Right percent. I've had somebody tell me they were called non compliant because their blood sugar their agency was six and a half and the doctor told him they didn't want to under seven, they call them non compliant. I think it's just something people throw around. It's a horrible it's a stick to hit people with, you know what I mean? So I think I think that when it Doctor calls you noncompliant because you're not having the outcomes that they want you to have. That's a false narrative. That just means you don't I mean, my experience now for this podcast, if you have the right tools, you can do it. If you have the wrong tools, it doesn't work out, you know, like, you can want me to do what you want. All you you have any idea how many you do, Jenny, Jenny does, I'm talking to all the rest of you, you have any idea how many people I talked to whose basal rates are so wrong, they couldn't possibly get good blood sugars, there's just no way for it to happen. And then they go back to the doctor and say, Look, you know, I'm 200 all the time, but I had this bad low, and sometimes the doctors back there bazel off more like, Oh, my God, it's going the wrong way. And then that same doctor will call them non compliant at some point,
Jennifer Smith, CDE 5:46
right? I think to help with it is,
even if you have no idea where to start and what you need help with, that's important to tell the doctor then I know something is wrong, I need help, or I know something's wrong, every time I go and take a run something is wrong. So you're giving them a focus area, you're giving the doctor something to say, Well, I can educate you about this. So I can give you strategic, you know, I guess guidelines to help with this. And we'll take a look at how it helps the next time. Unfortunately, a lot of times people come into their endo, and they expect the doctor to just say, well make an adjustment here make an adjustment here, oh, I'll see you in three to six months again, well, you're not giving the doctor any direction either then to be able to help you and your goals. And you
Scott Benner 6:33
by the way you could be there are people who are non compliant, by the way that that would be a way to address. And then there's going to be people to who psychologically for reasons of anxiety or stress or depression can't follow through to call that person non compliant. That's criminal, you don't mean so doctors really need to hear that there. There are other ways and better ways to address people and that no one wants to be called non compliant. That's a nice little technical word you use in your reports that shouldn't be said out loud to somebody. If that those weren't words meant for the patient. Those were words meant for your notes.
Jennifer Smith, CDE 7:11
And I don't even think they should be used in the notes. because quite honestly, then another clinician may come in later and think well noncompliant. Gosh, this person is not doing anything that we said. And that may not be the case. Instead, documentation needs to be more specific. It means to say, Well, you know, I talked to the person today because it appears in the records that they're they're missing boluses based on their CGM data, why are they missing boluses this, this topic was discussed, oh, I found out that they're really worried about low blood sugars, they have a high risk job, they've got something else going on. We discussed this, this is more of a psychological we need to overcome this isn't they don't want to take their medication the right way. This is they're trying to figure out a way around it or avoid something else happening.
Scott Benner 8:01
Right? details need to be added? 100% correct. It's just something that gets bandied about. And as if it covers all these different things. And really, it only speaks to one specific situation like like, and then it gets it gets. It gets attached to all these other people and their scenarios, and it just doesn't fit and it's hurtful. It's hurtful to have somebody tell you when you're trying so hard at something for someone while you're not trying. You're like man, you didn't give me any tools. I'm still I'm beating my head against this wall. I'm getting nowhere and you're gonna yell at me afterwards. Why am I coming here? You know, so that's all. I'm only gonna make you do that one today, Jenny, because that one was hard. Oh,
Jennifer Smith, CDE 8:41
that's a good one. No, very, very, very good one, I think.
Scott Benner 8:45
You know, I was looking online for medical definitions of non compliance and everything matches up with what Jenny said. But this one is interesting, it goes on cancer the initial definition to say, the cause or causes may be difficult to ascertain. The patient or client may have values and beliefs about health that are different from those of the healthcare provider or there may be other conflicts in the relationship that work against following the advice offered. In some cases, the patient or client may not have the financial resources, family support, physical ability or emotional stability to perform the prescribed tasks, poor self esteem, negative side effects of drugs and other forms of treatment and lack of progress, after adhering to their prescribed regimen can also lead to non compliance. Since it is assumed that the individual has sufficient knowledge to make the informed decision, lack of knowledge is not considered a likely cause of failure to comply. But that doesn't kind of count for diabetes, right? Because you can tell somebody something it doesn't mean they understood it. The nurse also should be aware that the patient or client may have the necessary knowledge and resources but have made an autonomous decision not to imply that someone Complete idea. I hope you enjoyed this episode of defining diabetes. Remember that it was brought to you by Dexcom on the pod and dancing for diabetes, there are links in your show notes if you'd like to find out more about them. As always, I appreciate you downloading the show, sharing it with others, leaving reviews and all the good things that you guys. I'll see you next week for the next episode.
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