SIX WAYS TO INFLUENCE THE NON-ADERENT PATIENT

Why would people go to the trouble of seeking out a healthcare provider’s medical advice only to neglect or reject the provider’s educated information? Discouraging? Absolutely.

But is this disregarding behavior by patients unique to any one specialty? Hardly. As long as there has been a doctor-patient relationship, there has been some degree of non-adherence. In fact, generally speaking, approximately 25 percent of patients on average are guilty of not following a doctor’s orders.1

Why are patients non-adherent? Reasons range from personal lifestyle restrictions to poor communication, fear and misunderstandings to a lack of social and/or professional support. If you would like to make more of an effort to reach and influence the non-adherent patients in your practice, here are a few things you can do.

1. Doctor–patient relationship. Trust is one of the key ingredients in terms of patient acceptance. It’s important to make the effort to build a solid relationship with patients first.  Gain their respect and trust, and then move on toward recommendation of clinical treatment plans.

2. Patient perception of severity. There is a good chance that the patient who presents with a painful, open, infected wound might recognize the severity of his or her condition. Fearing an even worse outcome, the patient might be more inclined to heed the healthcare professional’s advice. On the other hand, the patient who needs only a topical prescription to combat an itchy foot might be less concerned and therefore a bit more neglectful, and be non-adherent. Since patient perception and the associated fear factor play a significant role in the patient’s recovery, do not assume that those factors alone can steer the patient toward better adherence. Still, perception is reality.

3. Patient understanding/awareness. As the doctor, it’s up to you to help patients understand the necessity of the recommended treatment as well as the consequences that come with not heeding medical advice by communicating with patients in a language they can comprehend. Lose the medical jargon and speak only in layman’s terms. To paraphrase the words of Joe Miller (Denzel Washington’s character in the 1993 movie Philadelphia), “Explain it (to them) like (they’re) a 2-year-old.” The simpler, the better. Afterward, to drive it home, have the patient repeat it back to you. Also, pay attention to what patients are asking you so you can offer an appropriate, satisfactory response.

In a nutshell, patients want answers and the answers have to make sense to them. If they don’t, then patients do not see enough of a reason for doing it your way.

4. Encourage open communication. There is a 19 percent higher risk of non-adherence among patients whose physician communicates poorly than among patients whose physician communicates well.2 Take the necessary time to stop and actively listen to what it is patients have to say. Patients can immediately sense your unwillingness to hear their concerns and will tune you out quicker than you can say “cold shoulder.” Their logic is straightforward: Why should patients listen to what you have to say if you do not extend the same courtesy to them?

Tap into the patients’ thought process by saying, “Tell me what you are feeling.” Be careful not to push, criticize, embarrass or nag them into following a treatment plan. Making them feel uncomfortable or incapable only puts them on the defensive. Rather, speak to them in an empathetic (not a sympathetic) way. Your genuine compassion will go a long way in helping them stick to their goal and building that very critical “trust” relationship (see #1).

5. Every excuse under the sun. Educate and reinforce to your patients that everything you are recommending is in their best interest. If they reject your suggestion and fire back an excuse, you may want to be more flexible (if you can) and slightly alter the plan to better fit their unique lifestyle. Find out, on scale of 1-10, how committed or likely patients are to following through with your recommendations. Use this information to offer an alternative plan. While patients should be aware that a modified course of action could impede their healing expectations, the chance that they will adhere is increased because it doesn’t completely alter their routine.

6. Get their friends and family on board. The support of friends and family can strongly influence your patient’s willingness to comply. With the patient’s permission and minding all HIPAA rules, attempt to include and involve their loved ones in discussions whenever possible regarding your patient’s care. 

In Conclusion

The cost of non-adherence affects everyone. Patients may fail to heal or improve. Doctors face the clinical loss of managing their patients as well as potential risk management problems. Practices are burdened with administrative (scheduling and collection) issues. Face it. Patient non-adherence has, is and always will be a hindrance in health care. While it’s true that varying factors (age, type of treatment, severity of condition, etc.) all play a role in whether patients decide to “toe the line,” never underestimate your ability to help move them forward.

References

1. Miller TA, DeMatteo MR. Importance of family/social support and impact on adherence to diabetic therapy. Diabetes Metab Syndr Obes. 2013; 6:421–6.

2. Haskard Zolnierek KB, DeMatteo MR. Physician communication and patient adherence to treatment: a meta-analysis. Med Care. 2009; 47(8):826–34.