Coping With Chronic Illness: What Goes Wrong
When it comes to self-managing chronic conditions, patients often make mistakes.
Reviewed By Brunilda Nazario
The symptoms range from mild nuisances to crippling pain. Even if these less-than-pleasant reminders recede, the underlying conditions don't. Why? Because they're chronic, which means they cannot be cured. And they strike one in 10 Americans. Despite the incurable nature of chronic conditions, proper self-management can help ease associated symptoms and prevent complications. Why, then, do so many chronic conditions go uncontrolled?
"People tend to deny they have a chronic illness," says Kate Lorig, DrPH, RN, professor of medicine at Stanford University. And no wonder. Oftentimes, along with the diagnosis of a chronic condition, shocking in and of itself, comes the mandate to make several significant lifestyle changes -- immediately. Such news can overwhelm patients. Hence, this reaction: "Some people figure, 'I'm going to continue to do everything I did before,'" Lorig tells WebMD. Or they pick and choose elements of the regimen their doctors prescribe.
Common Mistakes in Self-Management
Experts on prevalent chronic conditions share with WebMD common self-management mistakes that patients make.
Tolerating less-than-optimal control happens all too frequently among people with asthma. "They accept discomfort and activity limitation rather than pushing their doctors for better control," says Norman Edelman, MD, dean of Stony Brook University's School of Medicine.
Improper use of inhaled asthma medication also ranks high on the list of asthma self-management mistakes. "Studies suggest that only about one-third of patients use them [inhalers] improperly," Edelman tells WebMD. This includes improper timing, or they may administer the medicine incorrectly. To help avoid these scenarios, Edelman urges patients to receive instruction from a qualified person on how to use inhalers before taking them home.
Many patients don't realize that once their asthma is under control they can work with their health care provider to possible reduce the need for certain drugs they take to get the disease under control.
Inadequate environmental control of allergens is another common faux pas. "Patients often keep furry pets despite clear allergies, and allow smoking in their homes, although smoking is a major irritant of airways," Edelman says.
Medication errors are not limited to people with asthma. Arthritis sufferers make them too, according to Hayes Wilson, MD, chief of rheumatology at Piedmont Hospital in Atlanta. "Some people get their prescription filled but never take it. Or they think to themselves, 'That sounds like an awful lot [of medicine]; maybe I'll just take it occasionally,'" Wilson tells WebMD.
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Arthritis is one of the main reasons people limit their physical activity. However, certain types of exercise have been shown to be beneficial to people with arthritis. Unfortunately, advice to exercise frequently goes unheeded.
People with arthritis tend to avoid exercise because they think it will hurt, explains Wilson. While he admits that engaging in exercise that applies pressure to an arthritic joint does seem counterintuitive, Wilson insists that not using the affected joint only makes it worse. So how can someone with painfully arthritic joints exercise effectively? "Having the guidance of a doctor and a physical therapist to help direct an exercise program for someone with arthritis can be quite helpful," Wilson says.
Thinking that pain is an acceptable part of arthritis results in poor control of the condition. "Most of my patients have pain. But some patients think there's nothing they can do about it," Wilson tells WebMD. That's not so, he counters. "There are always things to do. If you have pain in a joint, see a doctor, get it diagnosed, and get on a treatment plan," Wilson advises.
Low-impact exercises such as walking, swimming, or water aerobics are good choices for people with arthritis. Exercise improves strength, flexibility and allows someone with arthritis to better perform daily tasks.
Like other sufferers of chronic conditions, people with depression tend to make medication errors. "They may discontinue their medications too soon or not take them regularly," says Douglas G. Jacobs, MD, associate clinical professor of psychiatry at Harvard Medical School. Or they stop taking them when they begin to feel better, he explains.
Not fully understanding the recovery process is a mistake that can negatively impact self-management. "Patients may think of recovery as a straight line rather than a zigzagging one," Jacobs says. While setbacks are normal, he explains, patients sometimes think that by backsliding they have failed. "People often expect too much of themselves early in the treatment process," Jacobs says.
Withholding important information from doctors is an all-too-often, and extremely dangerous, mistake. "They [patients] don't let their doctor know when they have suicidal thoughts," Jacobs tells WebMD. Plus, some patients fail to tell their psychiatrist about other medications they're taking. "This could lead to possible harmful interactions," Jacobs warns.
Like other chronic conditions, diabetes doesn't allow for any slack in treatment adherence. But according to certified diabetes educator Michelle C. Sheldon-Rubio, RN, CDE, it happens a lot. "Some patients think management leads to control [of diabetes] and control leads to cure. So then they think, 'I can go back to my old habits'," says Sheldon-Rubio, education coordinator at the Joslin Diabetes Center at University of Maryland Medicine.
That's why effectively educating patients about the disease is critical. "Part of the education process is to let people know that diabetes is a progressive disease, and it is chronic," Sheldon-Rubio tells WebMD. She sees self-monitoring as key to this education process. "By getting people to take their blood sugar before a meal and two hours after, they can see how their blood glucose levels change after they eat. They get immediate feedback," she says. "The more people monitor their blood glucose levels, the better off they are."
Many people with diabetes also don't realize 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. Steven Nissen, MD, a cardiologist with The Cleveland Clinic, advises his patients to get automated blood pressure cuffs, take their pressure at home regularly, chart results, and bring them to office visits. "The best sampling of blood pressure is in routine daily life. It's a tremendously valuable part of the [doctor-patient] partnership," he tells WebMD.
Patients frequently fail at other components of this partnership, explains Nissen.
"The percentage of people who actually lose weight when you advise them to is about 5%," Nissen says. This, despite the central role that weight loss often plays in controlling heart disease.
Plus, many patients stop taking their cholesterol-lowering drugs without their doctor's approval. "They think they can take it temporarily and get benefits," Nissen says. "But cholesterol-lowering therapy is given for life. Patients are not comfortable being on medicine for life. We have to help people understand that having a chronic condition is not a fault," Nissen tells WebMD.
Published Feb. 7, 2005.
SOURCES: Kate Lorig, DrPH, RN, professor of medicine, Stanford University. Norman Edelman, MD, dean, School of Medicine, Stony Brook University. Hayes Wilson, MD, chief of rheumatology, Piedmont Hospital, Atlanta. Douglas G. Jacobs, MD, associate clinical professor of psychiatry, Harvard Medical School. Michelle C. Sheldon-Rubio, RN, education coordinator, Joslin Diabetes Center, University of Maryland. Steven Nissen, MD, cardiologist, The Cleveland Clinic.
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