What Should Doctors Do With the Non-Compliant Patient?
A patient whom the doctor finds is "non-compliant" (essentially does not accept or follow what the doctor advises or prescribes) is particularly troublesome for some doctors who, despite this age of patient autonomy, consider themselves in a "father knows best" role. They may look at their relationship with the patient, in an era of lowered payments for the time and expertise, as a waste of time and waste of their skills. However, patients may have complex psychosocial reasons and well as biologic (related to the illness or side-effects of prescribed medication) for not following the physician's advice. With regard to adherence to a drug prescription, the patient may because of finances either not purchase the drug or reduce its dosage frequency for the bottle of pills to last longer. For a description of how another doctor looks at the non-compliant patient, read an article from the Permanente Journal Fall 2003 by Fred Kleinsinger, MD titled “Understanding Noncompliant Behavior: Definitions and Causes”
“What should doctors do with the non-compliant patient?" I would agree with Dr. Kleinsinger, first talk to the patient and begin to understand the reason for the non-compliance. Then it is up to the doctor, not to ignore an issue but to actively attempt to mitigate it. This may range from obtaining a social worker to help the patient with ways of financing the medical regimen to ways of more easily getting to the doctor’s office or it may require the doctor to do things, along with patient education, like revising a dosage plan which is simpler and more likely to be followed but yet still potentially therapeutic. But first, the doctor must take the time to talk to the patient. Yes, this takes time but if there is no attempt by the doctor to recognize and find a solution for non-compliance further time "treating" the patient may be wasted to the detriment of the patient's health.
Have any of my visitors had problems with compliance with their physician's advice and prescriptions? ..Maurice.