Easing the Pain of the Noncompliant

"Medical noncompliance" is a phrase that makes even the most experienced hospitalist take a deep breath and force a smile as he gently explains to patients why they wound up in the emergency department.

We deal with this issue so often that it may even become second nature to breeze over this as we take a medical history, all the while cringing inside.

Who is to blame anyway? Well, there is often plenty of blame to go around. First of all, the patient is obviously at fault, sometimes unintentionally. He has failed to follow what we may consider to be simple instructions, and as a result, has wound up in the hospital yet again.

But what if there is more to the story?

Was the prescribing doctor too busy to explain to him the common, and sometimes unbearable, side effects of his medication? Maybe.

Was his caregiver remiss in not filling it on time or giving it as scheduled? Perhaps.

Does his insurance cover the entire amount, and if not, could it be that he cannot afford such an expensive drug on a fixed income? Strong possibility.

Or, does he simply not understand that his medication – which costs a lot of money and does not seem to make him feel any better (or may actually make him feel worse) – is in fact protecting him from a potentially catastrophic downward spiral that may culminate in his early demise?

Frequently the reason patients are noncompliant is multifactorial. But regardless of the reason, the bottom line is that the patient needs counseling, and there are a lot of missed opportunities to provide it. Even on a busy day, we can set the stage by introducing the basic concepts of what this medication is doing for him and then ask a nurse to print additional information on his condition for his reading pleasure. If he simply can’t remember to take his medications regularly, suggest that he purchase a pill box, fill it once per week, and keep it near his toothbrush, his refrigerator, or wherever else he will see it several times each day. If he cannot afford the medication or there are unpleasant side effects, explain that there may be alternative medications that may work just as well.

Part of the problem is that docs are too busy to counsel their patients – most leave it up to RNs to discuss pill bottles, etc. However, I believe patients are more likely to follow this advice when it comes from a physician, especially when they are hoping to go home ASAP. And so hospitalists must remind the noncompliant patient that he has to participate in his health to avoid returning to our care.

Certainly, this can be about reducing readmission rates, but it is at least as much about building a healthier patient overall.

Empowering patients to improve medication compliance only takes a few minutes, and can pay huge dividends for patients and physicians alike.

Dr. A. Maria Hester is a hospitalist with Baltimore Washington Medical Center who has a passion for empowering patients to partner in their health care. She wrote her first patient-empowerment book while still in medical school and later authored, "Your Family Medical Record: An Interactive Guide to Health and Self-Empowerment."

"Medical noncompliance" is a phrase that makes even the most experienced hospitalist take a deep breath and force a smile as he gently explains to patients why they wound up in the emergency department.

We deal with this issue so often that it may even become second nature to breeze over this as we take a medical history, all the while cringing inside.

Who is to blame anyway? Well, there is often plenty of blame to go around. First of all, the patient is obviously at fault, sometimes unintentionally. He has failed to follow what we may consider to be simple instructions, and as a result, has wound up in the hospital yet again.

But what if there is more to the story?

Was the prescribing doctor too busy to explain to him the common, and sometimes unbearable, side effects of his medication? Maybe.

Was his caregiver remiss in not filling it on time or giving it as scheduled? Perhaps.

Does his insurance cover the entire amount, and if not, could it be that he cannot afford such an expensive drug on a fixed income? Strong possibility.

Or, does he simply not understand that his medication – which costs a lot of money and does not seem to make him feel any better (or may actually make him feel worse) – is in fact protecting him from a potentially catastrophic downward spiral that may culminate in his early demise?

Frequently the reason patients are noncompliant is multifactorial. But regardless of the reason, the bottom line is that the patient needs counseling, and there are a lot of missed opportunities to provide it. Even on a busy day, we can set the stage by introducing the basic concepts of what this medication is doing for him and then ask a nurse to print additional information on his condition for his reading pleasure. If he simply can’t remember to take his medications regularly, suggest that he purchase a pill box, fill it once per week, and keep it near his toothbrush, his refrigerator, or wherever else he will see it several times each day. If he cannot afford the medication or there are unpleasant side effects, explain that there may be alternative medications that may work just as well.

Part of the problem is that docs are too busy to counsel their patients – most leave it up to RNs to discuss pill bottles, etc. However, I believe patients are more likely to follow this advice when it comes from a physician, especially when they are hoping to go home ASAP. And so hospitalists must remind the noncompliant patient that he has to participate in his health to avoid returning to our care.

Certainly, this can be about reducing readmission rates, but it is at least as much about building a healthier patient overall.

Empowering patients to improve medication compliance only takes a few minutes, and can pay huge dividends for patients and physicians alike.

Dr. A. Maria Hester is a hospitalist with Baltimore Washington Medical Center who has a passion for empowering patients to partner in their health care. She wrote her first patient-empowerment book while still in medical school and later authored, "Your Family Medical Record: An Interactive Guide to Health and Self-Empowerment."

"Medical noncompliance" is a phrase that makes even the most experienced hospitalist take a deep breath and force a smile as he gently explains to patients why they wound up in the emergency department.

We deal with this issue so often that it may even become second nature to breeze over this as we take a medical history, all the while cringing inside.

Who is to blame anyway? Well, there is often plenty of blame to go around. First of all, the patient is obviously at fault, sometimes unintentionally. He has failed to follow what we may consider to be simple instructions, and as a result, has wound up in the hospital yet again.

But what if there is more to the story?

Was the prescribing doctor too busy to explain to him the common, and sometimes unbearable, side effects of his medication? Maybe.

Was his caregiver remiss in not filling it on time or giving it as scheduled? Perhaps.

Does his insurance cover the entire amount, and if not, could it be that he cannot afford such an expensive drug on a fixed income? Strong possibility.

Or, does he simply not understand that his medication – which costs a lot of money and does not seem to make him feel any better (or may actually make him feel worse) – is in fact protecting him from a potentially catastrophic downward spiral that may culminate in his early demise?

Frequently the reason patients are noncompliant is multifactorial. But regardless of the reason, the bottom line is that the patient needs counseling, and there are a lot of missed opportunities to provide it. Even on a busy day, we can set the stage by introducing the basic concepts of what this medication is doing for him and then ask a nurse to print additional information on his condition for his reading pleasure. If he simply can’t remember to take his medications regularly, suggest that he purchase a pill box, fill it once per week, and keep it near his toothbrush, his refrigerator, or wherever else he will see it several times each day. If he cannot afford the medication or there are unpleasant side effects, explain that there may be alternative medications that may work just as well.

Part of the problem is that docs are too busy to counsel their patients – most leave it up to RNs to discuss pill bottles, etc. However, I believe patients are more likely to follow this advice when it comes from a physician, especially when they are hoping to go home ASAP. And so hospitalists must remind the noncompliant patient that he has to participate in his health to avoid returning to our care.

Certainly, this can be about reducing readmission rates, but it is at least as much about building a healthier patient overall.

Empowering patients to improve medication compliance only takes a few minutes, and can pay huge dividends for patients and physicians alike.

Dr. A. Maria Hester is a hospitalist with Baltimore Washington Medical Center who has a passion for empowering patients to partner in their health care. She wrote her first patient-empowerment book while still in medical school and later authored, "Your Family Medical Record: An Interactive Guide to Health and Self-Empowerment."