By Carla Schick
Last week, this comment was posted on the IG Living Facebook page: When a patient does not follow a doctor's treatment plan or discontinues medication sooner than advised, doctors refer to this behavior as "noncompliance." Statistics show noncompliance can result in higher healthcare costs, increased hospital admissions and a breakdown in doctor/patient communication. Have you ever been noncompliant, and if so, why?
We received numerous responses from fans, most of whom felt that noncompliance was necessary because of health concerns. If they experienced severe side effects from a particular medication, or if they felt that the doctor simply gave them a prescription to get them out of the office, they were "compliant in their noncompliance."
Let's face it: We've probably all been medically noncompliant at some point in our lives. Maybe we only took seven days' worth of our 10-day antibiotic, or perhaps we chose not to take a medication that was meant for depression because we didn't have depression; we just live in chronic pain. I'm guilty of defying my doctor's orders. Having recently been diagnosed with gastroesophageal reflux disease (GERD), my doctor gave me a prescription for Nexium, a once-a-day medication that works by decreasing the amount of acid made in the stomach. Not only did it not get rid of my chronic indigestion, but it caused terrible stomach pain, which I later found out was one of the long list of side effects caused by the medication. After taking only two days' worth of my 30-day prescription, I discontinued the medication because the stomach pain was unrelenting.
Doctors throw the word noncompliance around like we're breaking the law every time we don't follow their instructions. So this issue of noncompliance begs the questions: How can we as patients empower ourselves while maintaining respect for our physician? How can we take control of our healthcare without feeling like we've just been reprimanded?
Dr. Richard Frankel, a medical sociologist at Indiana University, helped develop a training program that Kaiser Permanente uses to teach their doctors to be better listeners. He says that oftentimes appointments are not productive because physicians assume that the first symptom or concern mentioned by the patient is the one that's the most important. However, Dr. Frankel notes: "Studies show that the most important symptom or worry… is often the third or fourth item on a patient's list, blurted out at the very end of an appointment."
In a scenario like the one Dr. Frankel describes, miscommunication could easily lead to what a doctor might later call noncompliance. The key, it seems, is better communication between patients and their healthcare providers.
Here are a few communication tips for patients from Dr. Frankel:
- Put all the items on the table at the start of the visit. If the doctor interrupts to focus on the first problem, say something like: "You know that's one concern, but maybe not my most important. Could I give you the full list before we go on so we can prioritize?"
- If you are afraid of offending your doctor by questioning or refusing a treatment or test, you could begin the discussion with: "Could you please review the benefits of this treatment for me again so that I can write them down? Good. Now could we talk about risks, too? OK, so tell me again why you think the benefits outweigh the risks in my case?
- Be specific and straightforward with your doctor. Instead of asking, "Is it important that I start this therapy next week?" don't be afraid to tell the doctor: "My cousin's wedding is next week, and I'd like to go. Would it be OK to start the therapy after that?"
- Bring a trusted friend or family member to your appointment to help make sure that delicate questions are asked and answered.
As patients, we need to respect our doctor's expertise. But when our gut tells us a particular medication or line of therapy isn't working, it's time to speak up and discuss other treatment options. If we are honest with our concerns, we stand a better chance of finding a more effective treatment plan. When all else fails, we can always disagree — without becoming disagreeable.
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Tell us about a time when you decided not to follow your physician's instructions.