By Elizabethe Holland
ST. LOUIS POST-DISPATCH
10/13/2005

Nancy Noedel's physicians were quick to realize she needed a little extra nudging to put her in good health.

An executive at St. Louis University Hospital and a single mother of two, Noedel wasn't eager to embrace medical advice after she was diagnosed with a chronic inflammatory lung disease two years ago. In particular, Noedel, 46, wasn't keen on the suggestion that she take time off from work on "bad lung days" - thus the extra nudging.

"My physicians have actually called the office to check to see if I've left," said Noedel, the hospital's director of quality. "If I answer the phone, they ask, 'Why are you at work?'"

Though it's a tag that makes Noedel bristle, many in the medical field would refer to her as a "noncompliant patient" - a person who ignores aspects of or even shuns doctors' advice.



Noncompliance is so common that it has become a frequent topic in medical writings and lectures. It's not unusual for people to fail to take prescribed medication, fail to change their diets or fail to follow through on tests that physicians order. Rams coach Mike Martz might be the latest high-profile example.

"I just assume it's a problem with everybody," said Dr. Mark Mengel, professor and chairman of the Department of Community and Family Medicine at the St. Louis University School of Medicine. "You sort of have to be, nowadays, a good salesman as a doctor because people want to be convinced that what you're telling them is the right thing."

Martz will be sidelined for weeks due to what is believed to be a bacterial infection of a heart valve. The coach continued to work while battling the illness, believed to be endocarditis. His condition worsened after the Rams game Sunday, and he was hospitalized. He later handed control of the team to Joe Vitt, assistant head coach and linebackers coach.

Martz told the Post-Dispatch that his doctor said that for at least two weeks, "I can't do anything." The coach said he expected to be sidelined for six weeks in all. Privately, though, he has told Rams President John Shaw he wants to return after two weeks.

Martz said he plans to do whatever physicians tell him, but in regard to being told he would need to be hospitalized for four to 12 days, he said: "I'm going to negotiate that one. I'm breaking out of here in two days."

Mengel said there isn't a prototype for a noncompliant patient. But workaholics can be especially challenging.

"It's pretty problematic for them because their lifestyles are so full," Mengel said. "They have a hard time integrating any health-related (changes) within their lifestyle."

Dr. Richard Wetzel, a Washington University professor of psychiatry, neurology and neurological surgery, said hard-charging people tend to not let anything interfere with their jobs.

"Their job is why they live, it's what they do, it's who they are, and they evaluate treatment against that. If the treatment doesn't interfere with that, OK. But if it does, then they're much more likely to make adjustments to the doctors' treatment that lets them do what they want to do."

Noedel empathizes with Martz and how he has had to step away from work and the people depending on him.

"It's more than just not going to work in the morning," said Noedel. "When you make a tremendous emotional and professional commitment to your job, it's hard to negotiate that when you have a chronic health condition. . . . When a large commitment is your work life, just to have that go away, even for an interim time period, you sort of lose a sense of yourself."

Former Rams coach Dick Vermeil, now head coach of the Kansas City Chiefs, understands that notion, perhaps better than most. Citing burnout, Vermeil in 1982 walked away from his position as head coach of the Philadelphia Eagles. The all-consuming job that had him sleeping in his office prompted desperate pleas from friends and family that he change his ways. He couldn't, so after seven seasons, he left.

"A lot of people told me I better stop it, and I had a doctor tell me that if you keep going, you're on a road to crash . . . and I ignored him," Vermeil said this week. " I didn't crash, but I just knew I couldn't be the coach I wanted to be in the frame of mind that I was in. . . . If I had been a good listener then, I wouldn't have had to step away. But I wasn't a good listener.

"There's a time in our lives that we all think we're built of steel."

Jack Buck, St. Louis' beloved Cardinals game announcer, knew he wasn't invincible. His son, announcer Joe Buck, credits his late father's longevity in part to the elder Buck's adherence to doctors' advice. Jack Buck died in 2002 at age 78 after battling a heart ailment, diabetes and other health issues.

"At no point during his last three years of his life did he ever defy any doctors' orders," Joe Buck said. "He was a smart guy who knew that the (doctors) who were telling him what he could and couldn't do knew what they were talking about, and he listened to them."

For years, health issues didn't slow Jack Buck down with his speaking engagements, his work with the Cardinals or his charity endeavors because he took care of himself, his son said. "He was, I think, very aware that he needed to do all that he could control to live as long as he could."

In Martz's case, a specialist phoned the Rams' Shaw after she met with the coach. Mengel, of SLU's medical school, has made similar phone calls to patients' bosses, in hopes of ensuring the patients do what they're told.

"Confidentiality is an important principle, but if you have a serious condition, particularly that's potentially fatal, you have to sort of violate confidentiality and take steps to make sure that a person cares for himself," Mengel said.

Noedel appreciates that her doctors have called to check on her - even though she admits she doesn't strictly adhere to their advice. Her job requires much of her, and if her son has a soccer game or her daughter wants to attend a football game, she doesn't like to say no.

"Do I do every single thing the doctors tell me, to the exact letter of the law? No, I don't," she said. "But I have taken what they've said and tried to make it fit me.

"What I've learned is that if I do better at taking care of myself and listening to the doctors, then I don't end up in the hospital for two or three days. But you have to work it into your whole life."