Lego and the false dichotomy of 'compliance'

On trying to put people in boxes

Oh hi, I wasn’t expecting you…

Stop by my house unexpectedly on any given Sunday afternoon and you’ll quickly understand a few things about me that’ll be quite different from if I knew you were coming and prepared for your arrival.

First up, you’ll realise how boring I really am. I’ll likely be home as I dislike having plans on a Sunday afternoon. It’s my time to recharge and get my shit together for the week. Buy some writing time by allowing the kids some screen time zombification. Independent activity time is enjoyed by all members of this household.

With this in mind, I’ll do my best to be polite and make sure you don’t notice I’d rather be enjoying my quiet time. I mean, it’s nice you made an effort, I’m not a total asshole.

I’ll offer you a drink, and hope you’re ok with tea, coffee, or soda water. Here’s where you’ll notice my boringness extends to the food and drink supplies I keep on hand. I’m not one of those ‘keep the fridge stocked and baking ready for visitors’ types. I would’ve if you’d called first, but you didn’t.

It’s too hot to sit outside today, so we’ll go take a seat in the loungeroom. Had I known you were coming, I would’ve tidied up. Instead, you get to see it in it’s natural state…floor littered with Lego in various stages of building.

This photo wasn’t staged for this post. My loungeroom as you would find it in its current state. Judge me as you see fit.

Super Mario is currently the dominant theme within our Lego world. An ever changing setup of courses. The new addition of Princess Peach (who looks kind of evil when her eyes aren’t alit). An army of characters sprinkled with Sonic the Hedgehog, a hint of freestyle architecture, and a parrot rounding out the guard that lines the top of the cabinet that sits in front of the TV.

According to The Lego Movie, there are two types of Lego builders: those who follow the instructions, and the Master Builders who don’t need instructions, choosing instead to create from their imagination.

Ah, a good old fashioned dichotomy.

You don’t have to go too far to find another dichotomous categorisation in the world of Lego. This time, breaking down those who build using the instructions into two distinct groups: those who carefully set out the contents of each bag as they progress through the instructions in a measured and orderly way, and those who dump the contents of the bag and sift through to find the piece they need when they need it.

The thing with dichotomies is, they rarely hold true.

Try as you might to put me into your neat little box, I don’t want to be there. Sure, I’ll build Lego using the instructions if it’s a brand new set. Most of the time, I’ll dump out the contents of the bag and inefficiently sift my way through looking for the pieces as needed. But occasionally if it’s really intricate and technical, I’ll take the organised route. And I’ll inevitably smash up the built Lego set and repurpose the parts for something made up from my imagination later on. I like living in the grey.

The same attempts to categorise people into false dichotomies is also evident in the world of medicine. Especially, when it comes to medicines.

What type of patient are you?

If you’re someone who uses prescription medicines on a regular basis, chances are you’ve had at least one interaction with a health professional where they ask you about whether or not you take your medicines as prescribed. Within this interaction, the healthcare professional is trying to make a determination of whether you’re compliant, or not. These days, they might wrap it up in different language to make it sound less patriarchal, and instead refer to you as adherent, or not. But it’s dichotomies all the way.

Are you a ‘good’ patient who follows instructions? Or, not.

We don’t have great data on it, but the figures that the World Health Organisation use are that around 50% of people don’t take their medicines as prescribed. I.e. around half of people could be considered ‘non-compliant’.

Around one third of this ‘non-compliance’ is unintentional - forgetting to take a dose or not getting the prescription refilled on time. The remaining two thirds, though, represent intentional decisions to deviate from the prescriber’s plan.

There may be very good reasons for someone to deviate from the plan. So let’s think about some of them.

Perhaps you realised that taking a particular medicine has an effect you don’t much enjoy. Say, it makes you go to the toilet frequently. You’ve got a social event on that day and so you decide to skip that medicine to alleviate the problem. Seems reasonable. You might do this a few times a month, or even a week, depending on your social life.

Or, maybe you don’t want to take the medicine because you were never really on board with being prescribed the drug in the first place. Your cholesterol level was high, sure. But that doesn’t mean you want to jump straight into taking a statin every day for the rest of your life! It was easier to just accept the prescription than get into it with the doctor at the time. Maybe at your next appointment you’ll talk about it. Maybe not.

These aren’t ‘deviant’ behaviours. They may not even be consistent across your other medicines, conditions, or over time. These decisions may well be based on completely sound logic and reasoning using the information you have available to you at the time.

However well intended though, independent decisions to take a medicine in a way other than prescribed can still result in problems in some circumstances.

Some medicines (like antidepressants and blood pressure tablets) can quickly cause withdrawal effects if you miss a dose or two. Other problems can be created as a result of missing information - when your doctor doesn’t realise you’re not taking the medicine as prescribed, and instead assumes you’re either not responding to therapy or have had a progression in your chronic condition.

The way to avoid these issues is to find health professionals that you trust, and talk honestly and openly with them about how you actually experience using your medicines in everyday life. Harder said than done sometimes, I know. But if you’re managing a chronic condition (or multiple) this is a relationship that’s worth the investment.

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And a song from an Australian about false dichotomies…