When following a treatment plan is difficult—and shame makes it hard to say so

Epigraph

“The fault of others is easily perceived”.

Dhammapada 252, opening clause, F. Max Müller, Project Gutenberg. The verse contrasts noticing another's faults with concealing one's own. Here the question addresses the habit of judging someone else, rather than a search for the patient's guilt.

What this article is about

Imagine Artyom at an appointment. He nods when asked whether he has followed the plan. An unopened packet remains at home: small instructions are difficult to read in the morning, and lack of money postponed the trip to collect the next supply. Saying that something is not working feels more dangerous than agreeing. Last time, someone told him that everything had already been explained. The present discussion therefore starts with an inaccurate picture: the plan is supposedly being followed, and only its outcome needs assessment.

The useful aim is to bring actual conditions back into the conversation. Not understanding, not obtaining something, being unable to carry out a step, fearing its consequences, and disagreeing are different difficulties. Shame can collapse them into a judgment about oneself. This article explores how to distinguish barriers again, communicate one manageable piece of information, and take treatment seriously without humiliation. It also examines older languages of discipline and help, asking where they illuminate this situation and where they add an unnecessary moral burden.

I. Following a plan begins with conditions that may be absent

A well-explained plan and a feasible plan are different achievements. Someone may understand its purpose but be unable to attend during service hours. They may obtain a medicine but be unable to open the packet. They may listen carefully and still not understand which instruction replaces another. Calling every difficulty inattention removes precisely the information that could change the help offered.

NICE CG76, section 1.2, recommends discussing difficulties without blame and matching support to the need. It distinguishes practical barriers from concerns, beliefs, and preferences. These are not two diagnostic boxes into which people must fit. Both can be present: a costly medicine can also cause worry about unwanted effects. Lower cost does not answer that worry; another explanation of benefits does not pay for transport.

In the example, the barriers occur at different points: understanding accessible information and obtaining the next supply. A useful solution follows that distinction. Before it is made, “I will try harder” merely carries the original uncertainty into the next appointment. Naming a condition changes the subject from character to a particular problem for which appropriate help can be considered.

II. Similar outcomes can have different explanations

“The plan is not being followed” describes the external picture too broadly. It may involve money or transport, unclear instructions, forgetting amid an overloaded day, an unwelcome change in how someone feels, or disagreement with the proposed option. This is neither an exhaustive list nor an explanation imposed on a person. It prevents one label from answering five different questions.

The distinction matters especially where support is limited. Another reminder does not make an unreadable instruction understandable. A new container does not explain an unwanted bodily change. Monitoring behaviour does not create agreement with a treatment's aim. A universal discipline device seems convenient only while nobody checks which problem it is supposed to solve.

Consequences and appropriate actions concerning medicines need clarification from a competent professional. A change does not establish its cause; fear neither proves danger nor makes a concern irrelevant. One can begin with the observation and a question: “Since the change I have noticed this; how urgently should we discuss it, and what should happen next?” The article offers no stopping, substitution, or missed-dose compensation schedule. Immediate danger takes priority over learning to describe a barrier perfectly.

III. A description need not become a verdict

In the Enchiridion, section 45, Epictetus warns against moving too quickly from observed behaviour to judgment. What happened may be visible while its grounds remain unknown. In a treatment conversation, this separates not having obtained a medicine from not caring about oneself. The latter claim is much broader and may conceal the fact that could actually be discussed.

A helper needs this pause too. They may see an untouched packet without knowing what the person misunderstood or feared. Asking what proved difficult is a different action from declaring irresponsibility. Yet the question must not become an interrogation with a predetermined correct answer. Sometimes a person cannot identify the reason immediately. Not having an explanation ready does not establish the worst interpretation.

Ancient ethics is not a study of modern patients' behaviour. We borrow the limited distinction between description and judgment, not the whole Stoic standard of self-command. A person may feel frightened, angry, or ashamed and still deserve understandable help. Becoming an emotionally untroubled speaker is not a prerequisite for being heard. Precise language is particularly valuable when speaking is difficult.

IV. Fear of punishment differs from ethical attentiveness

In verses 129–133 of the Dhammapada, recognising another's vulnerability is linked to refraining from harm and taking care in speech. Verses 252–253 criticise the habit of searching for others' faults. This religious and ethical setting poses a useful question for a helper: what am I doing with my power to judge? A reprimand that makes someone stop reporting difficulties can obstruct the discussion's very purpose.

Buddhist discipline, however, cannot be reduced to the contemporary instruction never to feel shame. The text includes demanding ethical standards and consequences extending beyond this article's frame. We therefore do not treat it as evidence that a friendly manner is clinically effective. The comparison is narrower: attention to another's suffering challenges the satisfaction of condemning them.

Artyom need not share a Buddhist worldview. He can simply recognise that reporting a missed step or an unavailable medicine differs from declaring himself a bad person. Responsibility for information is compatible with freedom from humiliation. Conversely, removing blame does not make possible medical consequences disappear. It makes room for a more accurate professional discussion instead of punishment within a family.

V. Who is the rule for?

In Mark 2:23–28, the dispute over the sabbath returns attention to the human being for whom the rule was established. This is a theological episode involving Jesus' authority. It cannot become general permission to disregard any rule, and certainly cannot establish whether changing a particular treatment is safe. It can nevertheless sharpen an ethical question about the purpose of an arrangement.

When monitoring compliance becomes an end in itself, the original purpose of help recedes. Artyom prepares an acceptable report rather than a discussion of difficulties. A helper receives confirmation of discipline, and a professional receives information that may not describe actual use. Outward compliance then obstructs understanding, although it began as an expression of concern.

The traditions differ substantially. Mark places the rule within a relationship to God and religious authority; Epictetus addresses accurate judgment; the Buddhist text concerns ethical conduct and liberation from defilements. They do not speak with one voice or invent CG76 in advance. Their meeting point here is a question about whether a living person disappears behind an apparently correct assessment of behaviour. Clinical decisions still require their own grounds.

VI. Information can be corrected without a complete confession

Previously saying that everything was being followed may obstruct a new discussion: now it seems necessary to explain an entire history of concealment. A limited correction can be enough to begin. “At the last appointment I did not explain that I had not obtained part of what was prescribed. I want to clarify the actual situation.” This does not guarantee a gentle response. It supplies new information without first requiring a biography of shame.

Separate what is known from what is assumed. Artyom knows the trip did not happen; he need not know exactly what consequences followed. He can say that an instruction was unclear without proving himself unintelligent. For a medicine-related question, current actions need professional clarification. Correcting information is not itself a medical decision, nor does it require changing behaviour to test someone else's theory.

The person can choose a helper's involvement. A helper might speak the opening sentence, convey a note, or read an explanation back. This does not authorise a confession before relatives. Relevant medical information goes to an appropriate recipient in the necessary scope. An absent or unsafe family must not be made the required route to honesty. Ask an accessible service about other support where possible, and state plainly when that support is unavailable.

VII. Advice cannot assume resources into existence

A plan to keep a detailed diary and log everything in an app may add work for someone already struggling with the central task. Sometimes one spoken sentence is enough: “I cannot currently obtain this medicine.” If speech is difficult, an accessible response or chosen communication support may help. Successful explanation is not measured by the number of boxes completed.

CG76 does not recommend one adherence intervention for everybody. For this question, that matters more than a list of devices. Check a proposal against the obstacle: does it address it, does the person want that involvement, and are the resources available to sustain it? A reminder that helps forgetting does not thereby answer cost, pain, or disagreement.

Sometimes no accessible solution is currently available. Motivation must not be used to hide that fact. A person can ask what actually exists within the local service and identify what remains unresolved. This article promises neither free medicine nor transport or a representative. Its limited benefit is to make a barrier visible and prepare a question about a feasible option. A system's responsibility should not quietly become another moral examination of the patient.

VIII. An acknowledged difficulty should change the conversation

Relief after telling the truth may matter, but does not establish that the difficulty is solved. Clarify what explanation was received, what was agreed, and what can actually be done. NICE NG197, section 1.2, gives attention to an understandable next plan and contact. It is organisational guidance, not a worldwide service guarantee or a universally safe waiting period.

Artyom may leave with one clarified question instead of promising never again: who can explain the instruction accessibly, and whom should he tell that the medicine remains unobtained? This is modest but grounded. If support depends on another person, their involvement and capacity need agreement rather than assumption.

At the opening, Artyom hid a difficulty to preserve the image of a good patient. He need not replace it with another ideal: a brave person who always speaks effortlessly and accurately. There can simply be room for clarification and correction. Care becomes more usable when reporting difficulty opens a next step without closing a person's access to respect.

What this means in practice

If an ordinary discussion is appropriate, choose one obstacle: cost or access, an unclear instruction, difficulty carrying something out, an unwelcome change, a concern, or disagreement. These are prompts, not a required questionnaire. “I want to clarify something: the plan is not happening as we have assumed. This is what gets in the way.” Leave unknown information unknown.

Ask for an explanation of next actions, their urgency, and who is available for another question. A general article cannot establish stopping, substitution, or missed-dose compensation instructions. Immediate danger calls for urgent medical help before this exercise.

Choose a manageable communication method: speech, a brief note, an accessible aid, or a chosen helper. State when proposed support assumes money, family, or a device that is absent. The result might be one corrected fact and an agreed contact. This is not evidence from actual reader testing or a promise that services will immediately remove every obstacle. It is a way to discuss real life rather than its convenient version.

Key quotation

“The sabbath was made for man”.

Mark 2:27, first clause, NABRE, USCCB. The context, 2:23–28, concerns the sabbath and religious authority. The quotation raises a question about a rule's purpose; it does not authorise independent changes to treatment.

Connections between traditions

Sources	Similarity and difference
Epictetus 45 / CG76 1.2	Description precedes judgment. Ancient ethics did not investigate treatment adherence; the guideline identifies practical barriers and concerns.
Dhammapada 129–133 / 252–253	Vulnerability and criticism of fault-finding challenge the judge's position. Religious moral discipline neither removes responsibility nor demonstrates clinical effectiveness.
Mark 2:23–28 / CG76 1.2	Attention to a person challenges monitoring for its own sake. A theological dispute supplies no clinical permission to disregard prescriptions.
Epictetus 45 / Dhammapada 252–253	Both restrain hasty judgment of others. Stoic work with impressions and Buddhist liberation from defilements have different purposes and grounds.
Mark 2 / NG197 1.2	An arrangement is questioned through its relationship to people. Shared clinical discussion has its own contemporary foundations; resemblance does not establish a single doctrine.

Sources

1. NICE CG76, section 1.2, 1.2.1–1.2.10. Read in the browser on 24 October 2026. Professional guidance on specific difficulties and support, not an individual prescription.
2. NICE NG197, section 1.2. Read section on involvement and subsequent plans; UK organisation of care does not guarantee local rights or services elsewhere.
3. Epictetus, Enchiridion 45, Elizabeth Carter. Primary philosophical text on observation and judgment.
4. Dhammapada 129–133, 252–253, F. Max Müller. Primary religious text in a historical translation; vulnerability, speech, and fault-finding.
5. Mark 2:23–28, NABRE, USCCB. Primary religious text; the rule and the person, without inference about clinical effectiveness.

Tags

treatment adherence, feasibility, shame, honest discussion, treatment difficulties, cost, access, instructions, misunderstanding, actual use, concerns, disagreement, unwanted effects, support, patient participation, correcting information, description, judgment, dignity, limited energy, spoken request, subsequent contact, Epictetus, Dhammapada, Mark, discipline, ethics of help

About the authors

Andrey Zarinsh is the author and founder of United Wisdom. He explores inner transformation, unity across traditions, intercultural dialogue, and contemporary spiritual discipline. Instagram: @andrey.zarinsh.

Maria Evilkut is a co-author of United Wisdom. Alongside her research, she seeks to test these ideas in practice and observe how principles of unity and mutual understanding work in real life between people and cultures. Instagram: @ilkutki.