There are two terms in the medical model for treatment which really bother me. One is "orders" and the other is "noncompliant". Why?
"Orders"
Doctors give orders. That is the medically correct term for what they do. This term truly bothers me. Granted, in a surgical procedure or in an emergency room setting I can see that under fire a doctor may give orders which need to be carried out quickly, efficiently and without question in order to save a life. Seconds can make the difference between life and death at times and in this setting "orders" make sense. But those orders are given to other medical personnel in the setting of a crisis.
The orders doctors more commonly give are to patients. And to this I object. Doctors should not "order" people how to take care of their own bodies as if they have no insight or intellect of their own. I have lived with this body a long time and know a little bit about its quirks. I might have something to contribute to the healing process. I might also have problems with side effects, the inefficacy of the medication in treating the symptoms, or other issues which make the doctor's "orders" hard to comply with. If these are not taken into account and the matter not discussed odds are the "orders" will not be carried out as intended. This is why patients do not finish the mediation regime or throw them out or do not take them as prescribed. And what is the reaction of the medical community when this happens?
"Noncompliant"
The patient is now labeled as "noncompliant". Oh I hate that term. As if patients are very small children or mindless sheep who require the doctor to think for them and dictate what they will do.
I vividly remember one client who was a perfect example of the application of these principles. (The details have been confabulated to protect confidentiality.) He was diagnosed with Schizophrenia and prescribed the appropriate medications. The client spent years in treatment trying various medications and dutifully following the doctor's orders without success. The problem? The client was also an artist. The antipsychotics prescribed for Schizophrenia totally shut down his creative processes. This client was unable to tolerate living in apartments or boarding homes due to his symptoms which were exacerbated in crowds of people. So he chose to live in the woods where he was secluded and life was quiet. After years of trying different meds he decided that the side effects were more severe than the symptoms and stopped taking them. Life without his art had no meaning, no purpose. He was simply a zombie walking around aimlessly. He lived in the woods with his dog and a few select friends who accepted his illness and respected his art and was quite content. He made a conscious choice of having his art at the price of having his symptoms. Yet he was labeled "noncompliant" for not following the doctor's "orders". This totally denies self volition. It denies our inherent right to make choices about our lives and to know what is best for ourselves. Yes, he is psychotic, but he is not violent and never was. He poses no threat to himself or others. He has a functional social network of friends who are supportive and caring. And he has his art which gives him a voice, gives him work, gives him meaning and purpose. Who can say that he his choice was not correct?
I have seen the same situation repeated with clients struggling with grief who mentioned it to the doctor, were diagnosed with "depression", were placed on antidepressants, experienced unacceptable side effects or emotional numbing and decided to stop the medications. When they tried to discuss it with the doctor they were labeled "noncompliant". The parents of children who are diagnosed with ADHD sometimes run into the same attitude if they object to the behaviors or side effects they see in their children after being placed on medications and then refuse to administer them.
Patients should not be labeled "noncompliant" for refusing to blindly follow "orders". Good doctors, and they do exist, prefer patients who take responsibility for their own health and participate as a partner in the decision making process of treatment. Good doctors also recognize that the medical model may not be the only way to address an issue, especially when it's psychological. They allow for natural remedies such as exercise, improved diet, counseling, yoga, meditation, etc. and may even prefer that a patient try these methods before starting a pharmaceutical intervention.
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