I don't know why I'm having so many thoughts about the term "noncompliant” today. Part of my issue with it is that it reveals how much HCPs start an interaction by disbelieving marginalized patients. The more axes of marginalization the more disbelief.
An example: every neurologist and ER doc I've met asks me if I have diabetes if I mention my nerve pain and paresthesia. They assume the cause is that bcuz I'm fat and Black and most HCPs hold the inaccurate belief that Type2 is caused by fatness and bad diet.
I'm not diabetic, I'm not prediabetic, nobody in my family has diabetes, they ask bcuz they make assumptions about me and my diet based on bias. They don't believe me when I tell them what my diet is like. They over test me for diabetes.
They always prescribe diet change and exercise, bcuz they assume I'm lazy and eat poorly. They persist in it despite my barriers to healthful food and exercise options and mark me noncompliant when I inevitably say I haven't implemented their vague advice bcuz barriers
They don't actually believe my barriers are what I say, that they're just excuses, lies, that there's more I could do, that there's more help and access than actually exists. That I'm an unreliable narrator, and so I'm noncompliant instead of facing barriers and distress
Noncompliant means an HCP thinks I'm a liar. Noncompliant means they don't need to care about me or work with me to find solutions, bcuz obvs the problem is I don't care about myself and aren't trying hard enough and am probably malingering (even tho there's nothing to gain)
And you'd think they'd be more prepped to believe me since I don't ask for pain relief, but HCPs are so primed to believe that Black ppl are drug seeking that they hyperfocus on pain I'm not really concerned about bcuz it's my other symptoms that cause the pain
of course they never offer meds for pain relief, always exercise and weight loss, aka things that will make my pain worse, and even tell me to ignore agonizing pain, even if I literally can't do it. Aka they're literally telling me to injure myself, otherwise I'll be noncompliant
This is another reason I get pissed off when white disabled ppl claim ableism is the same or worse than racism, and when they appropriate our hashtags and tell Black ppl to step aside and pipe down about their liberation and make way for white disabled ppl
Cuz the assumption is always that Black ppl don't actually suffer, that they're unreliable narrators, that they're to blame for their woes, that they don't experience ableism AND racism, that they exaggerate and have more than they really do
HCPs don't really ask or comment when I do talk about my pain, but they don't really ask or comment when I talk about my symptoms and how they affect my daily life or how they are the root cause of my pain. They latch to pain bcuz they can blow me off with dangerous instructions
Bcuz in the end they solidly believe that I'm a liar and the source of my own suffering, even if they don't realize that's what they believe. Medical and nursing schools still teach racist medicine, still teach that Black ppl don't care about their health
HCPs still believe that Black ppl are lazy and don't care about their health, that the problem is we're not doing enough and that systemic barriers like poverty and food deserts are weak excuses for being disgusting and irresponsible. "Noncompliant" is a weapon against us
Noncompliant signals to every HCP that sees it that this patient is pointless to help, that a patient is irresponsible, lazy, lying, and looking for an easy fix, maybe even malingering. "Noncompliant" means difficult or annoying, means attention seeking, means disregard this one
So yeah I hate that term with a passion, bcuz HCPs wield it like a club to destroy marginalized pts and force harm upon them, force neglect and gaslighting on them. It lets HCPs off the hook of examining their bias, of acknowledging systemic barriers. It enables lazy medicine.
But I mean lazy medicine is what most HCPs do for marginalized people, especially on multiple axes of oppression. That shit matters.
@threadreaderapp unroll
• • •
Missing some Tweet in this thread? You can try to
force a refresh
