How do we make patients listen to us? Do we speak to them in their native tongue? Do we deliver culturally sensitive messages? Do we use smart marketing techniques to get them to take their medication every day?
Yes, all of these things are helpful, but perhaps first we should look at the attitude behind the term “patient compliance.”
The word compliance alone indicates the action or fact of complying with a wish or command and indicates a meeting of rules or standards. Patient compliance then would be a patient adhering to the expert advice, suggestions or “orders” given to them by their doctor.
Compliance with medical treatment is based upon professional belief in the dominant role of a doctor to diagnose, prescribe and treat their patient to the best of their ability. It is a passive relationship in which the patient does what they are told.
Logically speaking then, non-adherence to medical treatment is a behavior that challenges this professional belief. This is when things get uncomfortable.
Taken as an affront, it is interpreted as the patient challenging the dominant role of their physician. Continuously ignoring doctors “orders” or making choices resulting in poor health outcomes is surely deviant and irrational behavior. Clearly this person must be sick to the point of incompetence or mentally ill. They must do as we say!
There are many reasons why a patient may reject the instructions of their doctor or refuse to take their medication, none of which are about challenging a doctor’s “authority.” Perhaps they did not understand the directive or its rationale. Maybe the directive collides with their religious beliefs or way of life. Maybe fear is at play.
Instead of expecting a patient’s compliance from a “do as I say” attitude, how about enlisting a partnership with a two-way conversation? Words have meaning. Change the term from “Patient Compliance” to “Patient Partnership.”
“Patient Partnership” requires an understanding of factors influencing a patient’s action in their healthcare: values, beliefs, attitudes, religion, previous healthcare experiences, stresses, and goals. Partnerships explain the “why” of the instructions. Treatment decisions become open communication and mutual agreement.
It will take extra time in the exam room but isn’t it worth skipping the repeat visit due to non-compliance, especially under the Affordable Health Care Act where repeat visits count against you?
Doctors and Pharma need to get off the high horse to partner with their patients instead of demand their compliance. Both parties need to ask “why” and discuss it – in their native tongue, of course.