Freedom: It is important to look at the patient’s history of medical compliance. One of the forms patients complete in my office relates to their medical and dental health care maintenance. How often and how recently have they seen a dentist? Do they have annual physical exams? Is there a family history of diabetes, hypertension, heart disease, and cancers?
What is their diet, exercise and do they have obvious signs of health care neglect such as obesity?
Many patients have been diagnosed with high blood pressure and/or type II diabetes. They have been told what modifications are needed to minimize their health risk. However, quite often, while they intellectually know about their various diseases, and see the consequences to family members, they attach no emotional significance to their health risks. They are not symptomatic, they enjoy eating, exercise is boring, and taking medication is both expensive and requires discipline. They consider self-neglect to be a freedom provided to them as part of life. If they focused upon health maintenance, they would not indulge in fast food and other damaging activities including smoking and excess drinking.
Interestingly, many of my patients take pride in no longer using recreational drugs. They feel that this is some form of triumph. Concurrently, ceasing to use drugs, creates for them the freedom to neglect themselves in other ways.
One thing that pre-injury health neglect creates is an unwillingness to schedule appointments, sit in waiting rooms, wait in line at a pharmacy, and spend their money on medication co-pays; they are not convinced that this adds anything to their quality of life. They have the freedom to live life as they wish.
Since other people die, but they are certain that they will not, there is little incentive to engage in health maintenance activities.
Once injured, they are being asked to compromise everything they hold dear: their God given right to self-abuse and avoid healthcare. Being “coerced” (in their thinking) to regularly see their authorized treating physician, to go to physical therapy and to maintain a medication schedule feels punitive, unrewarding and annoying.
(Interestingly, they use these very requirements to justify not looking at a post-injury future. “My days are so filled with [medical care] who has time to think about the future.”]
We are often up against a lifetime, lifestyle and family system in which health maintenance and wellness were never a consideration. To alter this, it will be imperative that the patient learn and begin to accept that recovery is not an automatic but, in fact, a process in which they must participate.