I’m sure you’ve seen this patient, too. He’s 17 years old. He’s visiting your office because of acne. He’s sitting on the end of the exam table. He’s wearing a baseball cap. Here in North Carolina, it’s actually a Jeff Gordon NASCAR cap.
The patient has a head full of curly hair, much of which is protruding — maybe “flowing” is a better word — out in all directions from under that hat. You can’t actually see his acne, or pretty much any of his face, because it is shrouded in darkness by his hat and hair.
His mother is on the other side of the room. She is adamant that you tell the boy to take his medicine properly. “He’s not doing it the way you said, Doctor. Tell him to use it the way you said!” she demands.
The Non-Compliant Adolescent
With the help of some lights and a polite request that he remove his hat, you find that he has moderately severe acne. It hasn’t improved as you would have hoped and expected based on the treatment prescribed at the last visit. His mom is right. He isn't using the medication as instructed. Why not? Doesn’t the acne bother him? Well, yes, it does bother him. But something else bothers him even more than the acne. Maybe a lot more.
First though, why is he wearing the ball cap? Many would think it is to hide the acne. It isn’t. He’s wearing the ball cap because his mom wants him to take it off. In fact, she’s a big Dale Earnhardt, Jr., fan, which is why he takes perverse pleasure in wearing a Jeff Gordon hat. (You can insert some other pair like Cubs/White Sox or Yankees/Red Sox if you are not from around here.)
Why is this teen’s hair so long? People might think that it’s to hide the acne, too, or that it’s simply in style among his peers. Those aren’t why. There’s only one reason why his hair is so long. He grows his hair long because his parents want it cut short.
The Real Reason
Mom’s right. The acne isn’t getting better because he isn’t using the medication. And the reason he’s not using the medication is because she’s haranguing him to use it. As much as the acne bothers him, there’s something weird about the teenage years that makes this young man do the opposite of what his parents tell him to do. When he hears mom say, “Don’t forget to take your medicine!” in her grating, irritating voice, (It may or may not be grating or irritating, objectively, but it is unquestionably grating and irritating the way he perceives it.) putting the medication on is the last thing he would do.
Teenage years are a time of developing independence. Some moms don’t like that. Sometimes it is a war. Medication use suffers. I’d like to do psychological tests to see how the psychology matches with the compliance behavior. I’m most interested in the result of the mom’s test. I suspect the more controlling she tends to be, the less the kid will use the medicine. Hardheadedness is probably a genetic trait, so the more hardheaded mom is about control, the more the kid is in response.
Meeting the Compliance Challenge
Anyway, this kind of dynamic is what makes acne treatment so much fun. Making the diagnosis of acne is no challenge. Prescribing an appropriate treatment plan for acne is no great challenge either. The challenge and the fun is in figuring out how to get the patient to use the medication!
I’m sure you’ve seen this patient, too. He’s 17 years old. He’s visiting your office because of acne. He’s sitting on the end of the exam table. He’s wearing a baseball cap. Here in North Carolina, it’s actually a Jeff Gordon NASCAR cap.
The patient has a head full of curly hair, much of which is protruding — maybe “flowing” is a better word — out in all directions from under that hat. You can’t actually see his acne, or pretty much any of his face, because it is shrouded in darkness by his hat and hair.
His mother is on the other side of the room. She is adamant that you tell the boy to take his medicine properly. “He’s not doing it the way you said, Doctor. Tell him to use it the way you said!” she demands.
The Non-Compliant Adolescent
With the help of some lights and a polite request that he remove his hat, you find that he has moderately severe acne. It hasn’t improved as you would have hoped and expected based on the treatment prescribed at the last visit. His mom is right. He isn't using the medication as instructed. Why not? Doesn’t the acne bother him? Well, yes, it does bother him. But something else bothers him even more than the acne. Maybe a lot more.
First though, why is he wearing the ball cap? Many would think it is to hide the acne. It isn’t. He’s wearing the ball cap because his mom wants him to take it off. In fact, she’s a big Dale Earnhardt, Jr., fan, which is why he takes perverse pleasure in wearing a Jeff Gordon hat. (You can insert some other pair like Cubs/White Sox or Yankees/Red Sox if you are not from around here.)
Why is this teen’s hair so long? People might think that it’s to hide the acne, too, or that it’s simply in style among his peers. Those aren’t why. There’s only one reason why his hair is so long. He grows his hair long because his parents want it cut short.
The Real Reason
Mom’s right. The acne isn’t getting better because he isn’t using the medication. And the reason he’s not using the medication is because she’s haranguing him to use it. As much as the acne bothers him, there’s something weird about the teenage years that makes this young man do the opposite of what his parents tell him to do. When he hears mom say, “Don’t forget to take your medicine!” in her grating, irritating voice, (It may or may not be grating or irritating, objectively, but it is unquestionably grating and irritating the way he perceives it.) putting the medication on is the last thing he would do.
Teenage years are a time of developing independence. Some moms don’t like that. Sometimes it is a war. Medication use suffers. I’d like to do psychological tests to see how the psychology matches with the compliance behavior. I’m most interested in the result of the mom’s test. I suspect the more controlling she tends to be, the less the kid will use the medicine. Hardheadedness is probably a genetic trait, so the more hardheaded mom is about control, the more the kid is in response.
Meeting the Compliance Challenge
Anyway, this kind of dynamic is what makes acne treatment so much fun. Making the diagnosis of acne is no challenge. Prescribing an appropriate treatment plan for acne is no great challenge either. The challenge and the fun is in figuring out how to get the patient to use the medication!
I’m sure you’ve seen this patient, too. He’s 17 years old. He’s visiting your office because of acne. He’s sitting on the end of the exam table. He’s wearing a baseball cap. Here in North Carolina, it’s actually a Jeff Gordon NASCAR cap.
The patient has a head full of curly hair, much of which is protruding — maybe “flowing” is a better word — out in all directions from under that hat. You can’t actually see his acne, or pretty much any of his face, because it is shrouded in darkness by his hat and hair.
His mother is on the other side of the room. She is adamant that you tell the boy to take his medicine properly. “He’s not doing it the way you said, Doctor. Tell him to use it the way you said!” she demands.
The Non-Compliant Adolescent
With the help of some lights and a polite request that he remove his hat, you find that he has moderately severe acne. It hasn’t improved as you would have hoped and expected based on the treatment prescribed at the last visit. His mom is right. He isn't using the medication as instructed. Why not? Doesn’t the acne bother him? Well, yes, it does bother him. But something else bothers him even more than the acne. Maybe a lot more.
First though, why is he wearing the ball cap? Many would think it is to hide the acne. It isn’t. He’s wearing the ball cap because his mom wants him to take it off. In fact, she’s a big Dale Earnhardt, Jr., fan, which is why he takes perverse pleasure in wearing a Jeff Gordon hat. (You can insert some other pair like Cubs/White Sox or Yankees/Red Sox if you are not from around here.)
Why is this teen’s hair so long? People might think that it’s to hide the acne, too, or that it’s simply in style among his peers. Those aren’t why. There’s only one reason why his hair is so long. He grows his hair long because his parents want it cut short.
The Real Reason
Mom’s right. The acne isn’t getting better because he isn’t using the medication. And the reason he’s not using the medication is because she’s haranguing him to use it. As much as the acne bothers him, there’s something weird about the teenage years that makes this young man do the opposite of what his parents tell him to do. When he hears mom say, “Don’t forget to take your medicine!” in her grating, irritating voice, (It may or may not be grating or irritating, objectively, but it is unquestionably grating and irritating the way he perceives it.) putting the medication on is the last thing he would do.
Teenage years are a time of developing independence. Some moms don’t like that. Sometimes it is a war. Medication use suffers. I’d like to do psychological tests to see how the psychology matches with the compliance behavior. I’m most interested in the result of the mom’s test. I suspect the more controlling she tends to be, the less the kid will use the medicine. Hardheadedness is probably a genetic trait, so the more hardheaded mom is about control, the more the kid is in response.
Meeting the Compliance Challenge
Anyway, this kind of dynamic is what makes acne treatment so much fun. Making the diagnosis of acne is no challenge. Prescribing an appropriate treatment plan for acne is no great challenge either. The challenge and the fun is in figuring out how to get the patient to use the medication!
