Had a recent consult with a patient that had their follow up supposed to be last week. Apparently they thought they felt better already so they didn't need to go back.
This happens a lot especially for patients managed on an out patient basis. They come in mentally disturbed about the voices inside their heads and then when prescribed with meds, they felt relief and somewhere down the future consults they get lost to follow up. The most common reasons were financial constraints to buy the meds (third world problems), they are too busy to pay attention to their mental health and prioritize work they eventually couldn't keep because their mental health is compromised, they live in far flung areas, or they just felt better and convinced themselves they don't need it.
In my mind, "Ah... so you felt better and thought you don't need the meds anymore because the problem is gone. I don't know, maybe the meds are actually working in your system that's why you felt better and should've just taken them regularly and followed up on schedule".
There's a polite way to say the stuff that's on my mind and I've employed different tactics to be confront a poor insight and poorly compliant behavior. They'll remember to come back to you when they feel sick and forget about you once they're fine.
There's a change in attitudes of chronic patients that I notice. The hallmark of a patient that is strictly adherent to their treatment regimen and found no current problems is that these patients are fine psych wise and think this whole regular follow up schedule is a nuisance rather than something they need. Because when they are in distress, they want immediate alleviation to the illness and once it's all done, they just get impatient waiting in line because the regular consult becomes a bother to their regular routine.
It happens to most disciplines in medicine but it's more profound on Psychiatry when we are more particular about observing people's reactions and attitude a lot.
Some of my patients prove to be a handful but not once have I ever thought about disliking them. This is the funny twist of perspective I learned while in Psychiatry, I have more patience when dealing with the insane than someone than is sane but refuses to be rational.
I do want to see my patients come back for consult right after they got discharged. I do keep them in my mind for trivial things like, are they taking their meds on time? their folks might be having a challenge trying to get them to take the meds?
These thought are just in passing as I go through my day. Sometimes when they don't show up, I just hope they come back still not in total disarray because then the management becomes harder than when they first had their episodes.
Repeated relapses become poor prognosis and for every relapse that happens, the challenge of making them get better takes a step higher.
I realized this isn't any different from how normal people actually behave and I'm not absolved from this habit too. There are definitely times when I only remember some people when I particularly am in need of something from them, exchange of information and etc., but it's all give and take. It's just more noticeable when the distress becomes overbearing.
Thanks for your time.