The term medication compliant has bothered me since Graduate School. It's almost always used as a negative, "Joe isn't getting better, he's no med complaint," "Client continues to hear voices- not med compliant." It gives no power to the person taking the medication and there seems to be little discussion as to why the client isn't taking medication. In outpatient setting I would ask and often hear responses such as the side effects were not bearable, they were homeless, forgetful, had ADHD (the irony of having ADHD and having to remember meds!) or they were on so many it was difficult to keep track.
I have tried in my career to ask more questions, allow clients to be the master of their lives and treatment and used more trauma-informed and empowering language. Verbiage such as "Client struggles with taking medication as prescribed due to...," "Client seeking assistance in understanding medication regime," or "Client states medication at night gives her nightmares and she has chosen to not continue."
Which brings me to what happened 2 weeks and 1 day ago. I don't usually share a large amount of personal information online, but I thought this illustrated a great point. I will use italics and bold to point out what clinical documentation would have said had I been in many counseling settings.
I had what I thought was a cold for 2 weeks and just started a new job. On Thursday I started to have tooth pain and ear pressure and decided to see a dentist thinking I might have a decay issue Alicia has not seen a dentist since the birth of her youngest child in early- 2015, she is unsure what month but estimates it was March. Client does not brush her teeth twice a day as recommended, states she flosses weekly "at best." She has been using the same tooth brush since that visit in 2015 and is aware she should be using a new one each year.
I called four dentists trying to find an appointment on Friday using my new insurance close by my office. I had an appointment and met with a new dentist, who stated I didn't have a cold, or tooth issue, but a sinus infection that was putting pressure on my teeth, ear and face. I was given a script for antibiotics. The dentist explained to take 3 a day, 8 hours apart for 2 weeks. I left work early, went to pharmacy and 30 minutes later was given the same dosage instructions. Alicia has been on antibiotics for similar issues twice year prior and also given same instruction, she stated that outcome was identical to this. She has also worked in the mental health field for 7 years, speaks with clients about important of medication compliance and has dosed her son 2xs a day for two weeks four times for ear infections. Client is well versed in antibiotic regimes.
I took my first dose that night with food as directed and put the large bottle in my purse. I wrote down on the back of an envelope the times I took the medications in order to keep track that weekend. I kept the pills with me at all times. On Sunday I went to bed and woke realizing I forgot a dose, but was half-asleep and didn't know if I should take one at 1:12am or wait until morning. I also didn't want to make some food or have a snack and have food breath while I slept. Alicia does not always brush her teeth before bed or after eating. Throughout the week I had moments where I would be counting the hours until my next dose and realizing it was middle of the night or before I woke up. I tried a 7am, 3pm, 11pm regime and would forgot or have a meeting and miss doses. Alicia did not consult her doctor, or read the pamphlet that was given to her but the pharmacist regarding missed doses or spacing medication apart.
After week one, I counted my pill bottle and realized I had missed 4 doses that week. Current rate of medication success was 17 out of 21 and I physically felt better. Client is aware that medication needs to be continued for the duration of medication even if she is feeling better. Over the next weekend I went grocery shopping and bought a few healthy granola-type bars to carry with me as one of my reason for skipping was because no food was around to take it with and it upset my stomach otherwise. I tossed those in my purse with the pill bottle. As I was feeling better and taking medication regularly I was less aware of the infection and forgot a few doses.
As I completed my two weeks on Friday I felt proud that I completed this task, while working full-time, on call crisis job, owning my own business and raising two small children. I did notice 7 pills remained in the bottle, but feeling better and confident I kicked the infection. Client was not med compliant, only taking 35 of the 42 pills given to her. She skipped doses, at times knowingly, didn't stick with a written plan, did not consult her doctor, pharmacist or pamphlet given to her. Alicia continues to lack med compliance with antibiotics. Her prognosis is fair, as she has done this in the past but is aware how to administer her own medication. She is lucky her infection as not returned at this point.