According to a recent Consumer Report survey, patients almost unanimously said they “completely” or “mostly” followed their doctor’s advice. But 59 percent of doctors said their patients often failed to adhere to the prescribed course of treatment.
“This survey offers useful information that will help doctors and patients partner more effectively,” says Vicki Rackner MD, founder of Medical Bridges. “The most revealing finding is the difference in compliance reporting between doctors and patients. I have long believed that doctors and patients enter and leave the exam room with different perspective, expectations and desired outcomes. This survey offers evidence that documents the differences.”
An informal Medical Bridges survey suggests the top five reasons that patients do not take medication as prescribed:
Denial
"I'm too young to have heart disease."
Side effects
"This medicine makes me feel worse..not better."
Lack of understanding
"The infection got better so I stopped taking the antibiotic."
Cost
"I can't afford this medicine."
Organizational skills
"I forgot/ I ran out."
Rackner notes that poor medication compliance, or failure of patients to take medication as prescribed translates to higher health care costs. An asthma inhaler is much less expensive than an ER visit for an asthma attack that occurs after a patient skips five doses of the medication. It's also a symptom of a much more fundamental problem: failure of doctors and patients to communicate. The solution involves doctors and patients being able to talk to each other and understand each others' perspectives.
"In an ideal world, doctors and patients hold a shared vision of the desired outcome of the medical intervention. They would agree to a course that leads to this destination and would consider the treatment plan to be a verbal contract they agree to honor. They would renegotiate the contract as needed. The strength of the relationship helps patients overcome their embarrassment about discussing medication side effects, or disclosing financial worries or overcoming their fear of being seen as a problem patient when they hold different health beliefs than the doctor such as the preference to avoid medication. Compliance requires doctor and patient to work together as a team," says Rackner
All participants in the health care system want the same thing: patients who enjoy optimal health, Rackner explains.
The health care providers who deliver the care, insurance companies and employers who pay for the care and patients who receive all benefit when patients are healthy. Prescription medication is a tool that helps achieve that outcome. We have the tools to make patient compliance an attainable goal.
Vicki Rackner MD, founder and president of Medical Bridges, is a board-certified surgeon and clinical instructor at the University of Washington School of Medicine. She helps businesses lower health care costs by investing in the doctor-patient relationship. She's an author, speaker and consultant.
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