How would you react if you found out there was a law that said you have to manage your diabetes in a certain way, and if you don’t follow the letter of the law, then you’ll be punished? Sounds a little absurd doesn’t it? But from the words some people use to talk about managing diabetes, you would think there’s some authority watching over you all times, shaking their finger at you every time you don’t do things the ‘right’ way.

The dictionary defines compliance as conformity in fulfilling official requirements. And this is a word that so many health care professionals and many patients use when they talk about diabetes management. Last time I checked, there is no law or rule about how anyone has to manage their health issues, including diabetes, yet the language some people use implies that there is. I’ve talked to a lot of doctors who say they just don’t understand what’s wrong with talking about ‘compliance’ and they get really defensive when someone asks them to change the words they use. Let’s dig a little deeper into the message that ‘compliance’ sends.

I don’t know about you, but I don’t like it when someone tells me what I must do, even (or especially) my doctor. Your relationship with your health care team should be collaborative, with you as the patient at the center of everything. When a healthcare provider uses the word compliance, what I hear is the provider believes that they’re an authority figure that I have to listen to. They make the rules and I have to follow the rules. The reality is health care providers are not authority figures. They are experts who can provide education, information and guidance to help you meet your health goals. As the patient, you are always the decision-maker, and you get to choose what to do with the advice you get from your doctor.

Your doctor is not a police officer, sitting there watching to make sure that you’re always following the speed limit and that you come to a complete stop at every stop sign. But it sure does feel that way sometimes. Going to the doctor can feel like you are going before a judge and praying that he or she will go easy on you – and don’t you dare test their authority. If you feel helpless and powerless in your relationship with you doctor – because of the language that they use or how they treat you (or both) – then it’s time to find a new doctor. Words matter. Doctors may use the word compliance out of habit or ignorance, but when they do, this attitude bleeds into how they treat their patients. Work to find doctors who are self-aware and who use language that empowers their patients, rather than empowering themselves.

People generally don’t thrive when they feel powerless. And while words don’t change the reality of the hard work needed to manage diabetes, words empower – and disempower – more than people realize. Managing diabetes requires perseverance, and if you feel like you’re failing, no matter what you do, it’s going to be hard to stay motivated to keep going. Seeing tangible benefits to your behavior will motivate you to keep going much more than ‘complying’ with your doctor’s orders will. We need to empower people in their own health, and telling people they must ‘comply’ with a diabetes treatment plan does just the opposite. Words like compliance send the wrong message.

I believe that diabetes providers, myself included, are serious about helping our patients feel good, stay healthy and live fulfilling lives with diabetes. Our primary role is to empower, but not by playing power games with the words we use. We do this by educating, guiding and supporting our patients in managing diabetes, not by requiring compliance. We have to let go of any illusion that we can force our patients to do anything. What we can do is empower them to make healthy choices, and this empowerment starts with the language we use.

5 replies on “The Problem with Compliance”

I have T1D and I’m also an RN, CDE. All of the diabetes health care providers I have met who are burned out, don’t trust or like their patients, and force people to jump through ridiculous hoops to access diabetes tech have been very much invested in the compliance dynamic. It’s not only difficult and disempowering for people with T1D to be in that dynamic; when you, as a provider, take your patients’diabetes too personally, and get frustrated when they aren’t meeting your goals and following your rules, you get burned out and bitter. Language matters to both the receiver and the speaker.

I agree. Just like with any other relationship, how a health care provider approaches their patient usually says more about the provider than it does the patient. Providers do get burned out and hopefully they recognize this and work to care for themselves rather than allow it to impact their interactions with their patients.

And changing compliance to “adherence” is just Symantec’s. I was on a call today where the speaker said adherence means the person has agreed to the care plan and then does not follow it. Totally removes the aspect of choice and needs/capacity. Here is a video people can share to help change the conversation!

I work in counselling and psychotherapy in the UK where we have a National Health Service which provides free care but where virtually all care is compliance based and authoritarian.

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