Non-Adherence: From a Doctor to a Patient Perspective
Throughout the years, doctors and individuals involved in the medical field and healthcare system have questioned the reasons for such high levels of non-adherence in patients, non-adherence meaning the lack of compliance of a patient to follow the prescription of the doctor for their ailment.
In a report addressing noncompliance, "Patient Non-compliance Statistics", we can see how around 40 percent of patients do not comply to their medication regimen, and what is even more staggering is that 1250,000 individuals die due to their non-adherence to medical treatment for illnesses that can be treated. But what causes individuals to become non-compliant?
Non-complaince has been a problem that many researchers have tried to identify, for which many have came up with different reasons. Some individuals have targeted the encounter between the doctor and the patient during the patient visit as one of the reasons for non-compliance, where basically the doctor does not communicate properly with the patient. Others like Dr. Daniella Omfri have argues that individuals are crammed with so much information and requirements to fulfill that it is difficult to comply:
Besides obtaining five prescriptions and getting to the pharmacy to fill them (and that’s assuming no hassles with the insurance company, and that the patient actually has insurance), the patient would also be expected to cut down on salt and fat at each meal, exercise three or four times per week, make it to doctors’ appointments, get blood tests before each appointment, check blood sugar, get flu shots – on top of remembering to take the morning pills and then the evening pills each and every day.
Added up, that’s more than 3,000 behaviors to attend to, each year, to be truly adherent to all of the doctor’s recommendations. Viewed in that light, one can see how difficult it is for a patient to remain fully compliant.The role of a patient can become very hectic, especially when you are expected to do so many things. However the reasons for such non-compliance is not because patients want to go against doctors or because they are loaded with so much information, which is all seen in a doctor-centered approach, rather they do not comply and instead self-regulate because they want to better manage their experience as a patient.
In an article called "The Meaning of Medications: Another Look at Compliance" by Peter Conrad, we can see how self-regulation is not a deviant act but rather a way to manage an illness as it progresses. Individuals tend to self-regulate depending on their illness experience, which is the experience that a patient goes through with an illness. Therefore, as individuals who are going through the actual illness experience and whom understand their illness, they tend to regulate their own medication regimen. As stated by Conrad, "the most common rationales for altering a medication practice are drug related: medication is perceived as ineffective if the so-called side effects become too troublesome”, which can clarify the" 30 to 50% of all patients [who] ignore or otherwise compromise instructions concerning their medications".
When we look at non-adherence through the perspective of a doctor all we understand is that patients continue to lack compliance to their medication and recommendations. However we must understand the patient's illness experience in order to see that it is not a patient being non-adherence, but rather a patient practicing self-regulation in order to manage their illness at the best possible way.
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I think a large issue with communication between patients and doctors is a failing to emphasize the significance of adherence to one's medication regimen. I think adherence is much more important in some cases as opposed to others (missing a dose of allergy medication as opposed to missing a dose of heart medication), I think speaking to patients in a more adult manner (rather than, "I'm the doctor, just take this it'll work") and attempting to break down why this drug was chosen and why it may help an illness would help patients make more informed decisions when choosing how to self-regulate. The fact that 250,000 individuals died as a result of non-adherence points to patients making often uninformed decisions in choosing not to abide to a treatment regimen, and as a healthcare provider, it's important doctors help patients understand the risk associated with not taking a dose (including if the risk is minimal). Ultimately, it comes down to the patient to decide to take abide to their doctor's recommendations, keeping patients informed can only serve to help them prioritize a treatment plan appropriately.
ReplyDeleteI agree with you in that I do not think we can necessarily blame the patients in their non-compliance. Stew, in his comment above, brings up a good point that the manner in which doctors communicate with their patients needs to be very inclusive and non-condescending, or what he calls "in a more adult manner."
ReplyDeleteThe doctor-patient relationship needs to be one of mutual respect and it is clear this is not the case in many of these instances. I have not been to medical school and cannot attest to the curriculum, but I hope that a good bedside manner is a part of the core instruction, though I am not sure that can be taught. My favorite doctor back home is like a friend in that I am comfortable asking questions and she answers honestly, in a way that I understand. I have had doctors that seem to get a real kick out of speaking in medical jargon and showing off that they know big words; I'm not easily impressed.
The rates on non-compliance will surely improve if doctors are trained to speak openly and assertively, without talking down to their patients. It seems like many believe that once their symptoms improve, they can stop taking their prescriptions, which is contributing to the lessening of the effectiveness of antibiotics, another issue worth addressing perhaps in a future post. I enjoy your blog a lot and love the format, as well.
This article is pretty interesting because I would have assumed for non-adherence to doctor specified regimen due to the patient feeling some sort of inaccuracy about the regimen. I’ve personally never received a regimen that I have felt to be too overwhelming, but on the other hand I’ve truly never been in a medical emergency. However, I do understand the idea of self-regulation in the patient due to the fact that the patient probably feels like they understand their symptoms and personal physical issues better than a doctor can and believe that once they feel better then they can stop their pharmaceutical regimen.
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