By Dr. Maria Alice
CHRONIC ILLNESS, once diagnosed, becomes a companion for the rest of your days and the worse thing is that you cannot even divorce it.
Coping with chronic conditions can go wrong in many ways, because patients often make mistakes when it comes to self-managing and, even if proper self-management helps to ease associated symptoms and prevent complications, many chronic conditions can get out of control.
The symptoms might range from mild nuisances to crippling pain, but even if these less-than-pleasant reminders recede, the underlying conditions do not, because they are chronic, which means there is no cure. They attack more or less one in 10 people.
No wonder people tend to deny having a chronic illness, as very often, along with the diagnosis of a chronic condition, shocking in itself, comes the “order” to immediately make several significant lifestyle changes.
Some react by denial, not accepting reality and deciding that they will continue to do everything they did before, or they just choose whatever they like from what their doctors prescribe, forgetting all about the other recommendations that are considered to be unsuitable and exaggerated.
A long-term or chronic condition affects not only the sufferer, but the entire family’s social life, physical health, emotional stability and financial resources as well.
What is chronic illness?
Having a temporary condition that is going to get better is one thing, a chronic illness has a completely different impact on the lives of patients and their family members. Chronic means that the patient’s health is affected by the illness, either intermittently or daily, over an extended and often indefinite period of time.
An acute illness may be serious, but once diagnosed it can be treated and resolved. In the case of chronic illness, it is different, as receiving the diagnosis is only the beginning of a long story – the loss of health and consequently of lifestyle comes along and, to top it all, the worry about the future, as secure plans may suddenly be disrupted.
To regain control it is fundamental to learn as much as possible about the condition, as the more information you have the more in control you will feel.
Chronic illnesses are not just the province of the elderly. They can surface years earlier, often driven by hazards such as smoking, poor nutrition and inactivity. A glance around the waiting room in your family doctor’s office and you will see many people that may be facing more than one chronic illness, even if they are only in middle age. It can start from childhood.
In a Canadian study of 980 adults treated by 21 family doctors, nine out of 10 had more than one chronic condition. Nearly half of the middle-aged patients (aged 45-64) had five or more chronic conditions.
High blood pressure, high cholesterol, depression, asthma, diabetes, arthritis, anxiety, osteoporosis, chronic obstructive pulmonary disease, coronary artery disease and rheumatological diseases are the most common. The good news is that those conditions can be treated and, even better, a healthy lifestyle including a good diet and adequate exercise can help.
Mistakes in self-management
Tolerating less-than-optimal control of symptoms happens frequently, with people accepting discomfort and activity limitation rather than pushing their doctors for better control.
Improper use of medication also ranks high on the list of self-management mistakes. Many patients do not realise that once their illness is under control they can work with their doctor to possibly reduce the need for certain drugs they take.
Others get their prescription, but never take it and, even when they start taking it, may discontinue their medications too soon, not take them regularly or think that it sounds like an awful lot of tablets, all resulting in poor control of the conditions.
Not fully understanding the recovery process is another mistake that can negatively impact self-management, but withholding important information from doctors is also a very, very dangerous mistake.
Diabetes does not allow for any slack in treatment adherence, but it happens a lot. Some patients think management leads to control of diabetes and control leads to cure. So, once they achieve a good control they think, “I can go back to my old habits.” Many people with diabetes do not realise the importance of routine exercise and weight control in helping keep their blood glucose under control.
Regular self-monitoring also plays a significant role in managing heart disease as the best sampling of blood pressure is in routine daily life. Despite the central role that weight loss often plays in controlling heart disease, the percentage of people who actually lose weight when advised to is only about five per cent.
Patients are not comfortable being on medicine for life, an example is that many patients stop taking their cholesterol-lowering drugs without their doctor’s approval, as they think they can take it temporarily only until values come down to normal. Cholesterol-lowering therapy, like a lot of other treatments for chronic ailments, is given for life, as when normal values are achieved a permanent maintenance dosage is necessary to keep it controlled.
The doctor-patient partnership
This is a tremendously valuable part of the strategies to enhance patients’ adherence to chronic illness management. The problem of poor patient adherence has been extensively researched, but the rates of non-adherence have not changed much in the past three decades. Healthcare providers play a unique and important role in assisting patients’ healthy behaviour changes.
Studies have shown that in the United States alone, non-adherence to medications causes 125,000 deaths annually and accounts for 10 to 25 per cent of hospital and nursing home admissions. This makes non-adherence to medications one of the largest and most expensive disease categories. Moreover, patient non-adherence is not limited to medications alone. It can also take many other forms, including the failure to keep appointments, to follow recommended dietary or other lifestyle changes and to follow other aspects of treatment or recommended preventive health practices. Hence, the actual implications of non-adherence go far beyond the financial aspect of medication non-adherence.
The complexity of a treatment regimen can affect adherence. For example, adherence improves remarkably when a patient is prescribed a pill that can be taken once a day. It is fundamental to keep it simple.
Research has also consistently demonstrated that patients’ understanding of their conditions and treatments is positively related to adherence.
Many studies have shown that patients do not always understand prescription instructions and often forget considerable portions of what healthcare practitioners tell them, and that patients who understand the purpose of the prescription are twice more likely to fill it than those who do not.
Physician-patient communication encompasses interventions ranging from physician-patient direct contact, sending mail or telephonic reminders, to involving patients’ families in the dialogue. The family’s role becomes all the more important if a patient is suffering from a chronic disabling condition requiring continued support and understanding.
Forgetting, not denying
Learn all you feel you need to know about your condition. Hear what your healthcare professionals are saying. Become familiar with your medication requirements, the monitoring needs of your illness and medications and warning signs of problems. Take regular time away from your illness and emphasise the capabilities that you still have.
Eating a balanced diet and taking time to relax can rejuvenate you. Reserve time for yourself and use it, as you will be in optimal condition to face the challenges of your illness if you have refreshed yourself.
Developing a positive attitude does help and does not mean denying that you have a chronic illness. It means not focusing on the negative aspects of your illness all the time and learning to minimise emphasising the bothersome features of your disease.
If coping remains too difficult, let your doctor know your feelings, as there may be many options available to you that you can access.
Chronic illness is a companion for life, a companion you need to learn how to live with the best possible way. Your doctor is the “counsellor” that will help you to cope with the difficulties of the journey and make the most out of it.
Best health wishes,
Dr. Maria Alice
Consultant in General and Family Medicine
Director – Luzdoc International Medical Service
