K. R. Sethuraman
39 Non-compliance The mule and his Burdens: A tradesman bought two sacks of salt, loaded them on
his mule and was returning home. On the way, while crossing a stream, the mule fell down by accident. When he got back on to his legs, the burden was much less as much of the salt had dissolved away. The tradesman went back to buy more salt and was again on his way home. This time around, the mule feigned a fall and lay
down in the stream to reduce its burden of salt. The master detected the trick and
turning back again, he bought a huge pile of sponges and loaded it on the mule. While crossing the stream, the mule sank into the water. Alas! When he tried to get up, the burden was much heavier, as the sponges had soaked up much of the water.
Ravi, a 45-year old businessman, felt cramped by all the lifestyle changes advised by
his doctor to control his diabetes. He did not follow any of the advice except for two days
before the next check-up and blood tests. He could fool his doctor initially but later the
doctor suspected non-compliance. The doctor ordered a special test (glycosylated
haemoglobin) that reveals control of diabetes over the previous three months. Ravi's noncompliance was thus exposed. Comments Doctors tend to overestimate compliance of their patients (Norrel SE, 1981). They
often presume that all the patients diligently follow their advice. The patients may feel
burdened by treatment advice especially the life style changes and unpleasant procedures or medications. "You must take it. It is for your own good." is all that most doctors can 114
