Why Comply?

This morning I was reading Living a Life That Matters by Harold Kushner. I was reading to pass the time on the dreaded “Oompa Loompa Machine,” but more about that tomorrow. Kushner mentioned Lawrence Kohlberg’s “three stages of moral development: doing right out of fear of punishment, doing right out of a feeling of communal solidarity with others, and doing right because it is right. I believe this has implications about how and whether we comply with our treatment plans.

There is one rheumatologist in my city who terrifies patients into compliance. He tells them they have stage four lupus (there are no stages in lupus) and that if they don’t take the medicine they will DIE! I know a rheumatologist who will not renew a patient’s prescription for hydroxychloroquine or plaquenil (a maintenance immunosuppressive that most lupus patients take for life) unless they produce the results of their annual eye exam. That’s not punishment. It’s more of a strong nudge because she cares. Most of the people in my lupus support group take their hydroxychloroquine without much concern. There is a kind of camaraderie about shared minor and major annoyances caused by lupus. But we take our meds knowing we are all in the same boat. This solidarity makes it easier for new patients to take their meds too.

But if you take away the threatening doctor, the nudging doctor, or the camaraderie of the group some patients will slip up. The bottom line has to be that we follow our treatment regimen because we know it is the right thing to do to control our disease.