Dr LeCrone
03-30-2006, 09:22 AM
One of the biggest problems health-care professionals face in dealing with patients is the issue of compliance, that is, the willingness of the patient to follow the doctor’s directions in treatment.
That age-old problem – how to get your patient to follow the prescribed treatment plan, including medications – is an issue that has pervaded medical and psychological literature.
Many areas in medicine and health care require strict compliance and obedience. For instance, the diabetic may need to take injections of insulin at prescribed times and follow a strict diet. The hypertensive patient may need to follow a strict diet, including the elimination or reduction of sodium. The smoker may need to cease his habit. The overweight person may need to go on a strict diet. Certain infectious diseases may require strict adherence to prescription medication.
As professionals, we often are faced with patients who seem to be asking for help but do not follow advice given them. When we encounter a patient who seemingly wants our help but rejects the prescribed advice or medication, we feel frustrated. In the field of mental health, we often encounter patients advised to alter their lifestyle or thought pattern only to encounter the “yes, but doctor” syndrome.
These individuals have an ingenious way of thwarting the advice. Their excuses range from “it wasn’t convenient,” to “my friend said it wouldn’t work.” Patients have the right to question the consequences of prescribed treatment. In fact, it helps in the compliance process. But a patient who thoroughly understands the treatment process should adhere or realize that their time and money have been wasted. They need to re-evaluate their motivation for seeking medical or psychological help.
Reasons for non-compliance range from misunderstanding to rebelliousness. Many of these can be modified with help.
• Younger family members should often accompany elderly patients to the professional consultation to avoid misunderstanding when the elder patient may have memory or intellectual impairment.
• Family members should accompany patients who will resist prescribed treatment. For instance, the suggestion of an exercise program may be refused by patients who do not play to change their lifestyle.
• A spouse should be present to receive information on diet plans or when information is requested at certain intervals on weight change or sugar levels.
One of the techniques being used more frequently is increased feedback from the patient to the doctor. Nurses or other trained professionals can monitor patient information as to the net step in the treatment plan. Another innovative technique to encourage patient compliance is participation in support groups, such as smoking cessation or weight control. Sometimes it is necessary to consult others in the profession to discern the reluctance of the patient to comply with medical advice. Sometimes a second or third opinion is needed to get the patient to comply.
I have encountered patients in my practice who did not comply with dietary prescriptions for diabetes because of an underlying depression and reluctance to go on living because of other factors in their lives. I also have encountered patients who feared surgery. Their fear was so great that intervention from other health-care professionals was necessary to overcome the anxiety.
When patient compliance is the conflict, talking it over with family members is frequently helpful, and good results can be achieved.
Harold H. LeCrone, Jr., Ph.D. Copyright 1986
That age-old problem – how to get your patient to follow the prescribed treatment plan, including medications – is an issue that has pervaded medical and psychological literature.
Many areas in medicine and health care require strict compliance and obedience. For instance, the diabetic may need to take injections of insulin at prescribed times and follow a strict diet. The hypertensive patient may need to follow a strict diet, including the elimination or reduction of sodium. The smoker may need to cease his habit. The overweight person may need to go on a strict diet. Certain infectious diseases may require strict adherence to prescription medication.
As professionals, we often are faced with patients who seem to be asking for help but do not follow advice given them. When we encounter a patient who seemingly wants our help but rejects the prescribed advice or medication, we feel frustrated. In the field of mental health, we often encounter patients advised to alter their lifestyle or thought pattern only to encounter the “yes, but doctor” syndrome.
These individuals have an ingenious way of thwarting the advice. Their excuses range from “it wasn’t convenient,” to “my friend said it wouldn’t work.” Patients have the right to question the consequences of prescribed treatment. In fact, it helps in the compliance process. But a patient who thoroughly understands the treatment process should adhere or realize that their time and money have been wasted. They need to re-evaluate their motivation for seeking medical or psychological help.
Reasons for non-compliance range from misunderstanding to rebelliousness. Many of these can be modified with help.
• Younger family members should often accompany elderly patients to the professional consultation to avoid misunderstanding when the elder patient may have memory or intellectual impairment.
• Family members should accompany patients who will resist prescribed treatment. For instance, the suggestion of an exercise program may be refused by patients who do not play to change their lifestyle.
• A spouse should be present to receive information on diet plans or when information is requested at certain intervals on weight change or sugar levels.
One of the techniques being used more frequently is increased feedback from the patient to the doctor. Nurses or other trained professionals can monitor patient information as to the net step in the treatment plan. Another innovative technique to encourage patient compliance is participation in support groups, such as smoking cessation or weight control. Sometimes it is necessary to consult others in the profession to discern the reluctance of the patient to comply with medical advice. Sometimes a second or third opinion is needed to get the patient to comply.
I have encountered patients in my practice who did not comply with dietary prescriptions for diabetes because of an underlying depression and reluctance to go on living because of other factors in their lives. I also have encountered patients who feared surgery. Their fear was so great that intervention from other health-care professionals was necessary to overcome the anxiety.
When patient compliance is the conflict, talking it over with family members is frequently helpful, and good results can be achieved.
Harold H. LeCrone, Jr., Ph.D. Copyright 1986