Tag Archives: non-adherence

Improving The Way Doctors And Patients Communicate – A Silver Bullet For Fixing What’s Wrong With Health Care?

Physician_Patient Communications InfographicSometimes a picture is worth a thousand words…

The Fastest Way To Disempower, De-Activate, and Disengage Any Patient

I may not know how to tell the difference between an empowered patient, an engaged patient, or an activated patient.  But I do know that fastest way to disempower, disengage, and de-activate any patient is a trip to the doctor’s office or the hospital.  A visit to an average primary care physician (or specialist) is to an empowered/activated/engaged patient what Kryptonite is to Superman.  It will stop all but the strongest willed patients dead in their tracks.

We patients have been socialized that way.   Think about your earliest memories of “going to the doctor.”  For me, I remember my Mom taking me to the Pediatrician.  Early on I learned by watching the interaction between my Mom and the doctor that they each had a role.  The doctor’s role was that of expert – he spoke and my Mom listened.  I was there just to have one or more extremities twisted and prodded.  And oh the medicinal smell…

Things haven’t changed much in the 40 years since I was a kid sitting in Dr. Adam’s office.  Well maybe the smell isn’t as medicinal.  But the roles played by doctors and patients haven’t changed much.   Studies over the last 30 years consistently demonstrate this unfortunate reality.  If you were to believe the admonitions of the NIH, AHRQ, hospitals, pharma and every WebMD-look alike, you would think that patients these days would be more involved in their visit…asking questions, sharing information and making decisions.  But as most physicians will attest…most patients don’t have much to say in the exam room anyway.   And the longer they have to wait before being seen, the less patients are likely to bring up the few questions they wanted to ask.

This is a huge problem.  It belies conventional wisdom that the key to fixing health care begins and ends with changing patient behavior.  If only we could get patients to be more compliant, if only patients would do what I tell them, blah, blah, blah.

Physician behavior, specifically, the way they think about, relate to and talk to patients needs to change (no e-mail, text messages and social media will not solve this problem)…before long term, sustainable change in patient behavior is possible.

If you look at most theoretical models underpinning patient empowerment, patient activation, etc., you will see that none of them factor in the impact of the care delivery context, e.g., doctor’s office, hospital room, surgery suite, or pharmacy, on patient behavior.   A patient considered Stage IV (Activated) on the Patient Activation Model (PAM) or the “Action Phase” using Stages of Change would “crash and burn” if their doctor is among the majority who employ a traditional physician-dominated, biomedical communication style or “bedside manner.”

How empowered, activated, or engaged can a patient be if they don’t know when to open their mouth, are ignored , or fear taking up too much of the doctor’s time?

Yes you can and should probably change physicians…but since so many physicians “practice” the same way…even supposedly Patient Centered Medical Homes…what’s the point?

Until health plans and providers take a serious look at incentivizing physicians to become more patient or relationship centered, behavior change efforts directed at patients can only accomplish just so much.

That’s my opinion.  What’s yours?

Sources:

Cegala, D. An Exploration of Factors Promoting Patient Participation in Primary Care Medical Interviews.  Health Communication, March 2011.  1–10, 2011.

Related Posts:

6 Seconds To More Effective Physician-Patient Communications

Lack Of Time And Reimbursement  – Is That Why Physicians Don’t Do a Better Job Communicating With Patients? 

Poor Doctor-Patient Communication Is Closely Linked To Non-Adherence

[tweetmeme source=”Healthmessaging” only_single=false]I am a big fan of Infographics.  They are a great for turning otherwise complex data into practical information.  Here’s an Infographic I built to describe the “disconnect” that often occurs between physicians and patients and the impact of adherence.

Rx Non-Compliance and Ineffective Physician-Patient Communication – Two Sides Of The Same Coin

[tweetmeme source=”Healthmessaging” only_single=false]Lots of smart people over the years have been trying to figure out why people stop taking their medications within the first 12 months.  Within the first 12-months of starting a new prescription, patient compliance rates drop to less than 50%.  This rate is even lower for people with multiple chronic conditions taking one or more prescription medications.
 
If these medications are so important to patients, why do they just stop taking them? It defies common sense. Sure issues like medication cost, forgetfulness, lack of symptoms, and psychosocial issues like depression play a role in patient non-compliance. But there also something else going on…or in this case not going on.
 
The problem is that doctors and patients simply don’t talk much about new medications once prescribed. Here’s what I mean.  Let’s say that at a routine check-up a physician tells a patient that he/she wants to put them on a medication to help them control their cholesterol.  The doctor spends about 50 seconds telling the patient about the medication.  The patient nods their head takes the prescription and boom…the visit is over.
 
Let’s say the patient actually gets the prescription filled.  For some people that is a leap of faith considering the likely chain of events up to that moment:

     

  • The physician didn’t really make a good case for why they needed the medication (if the doctor wanted me to take it he/she should have been emphatic about it as in “I recommend you take this” – not simple “I want to try something”), what it would do or what would happen if the patient didn’t take it.
  • The doctor didn’t mention how the new medication would interact with the 2 other pills I am already taking.
  • Consequentially the patient may not believe they really need the medication.

 
Fast forward 12 months. The patient has been back to see the same doctor twice for problem unrelated to cholesterol. At neither of these appointments did the doctor mentioned or ask how the patient was doing with the new medication. The doctor did mention the need for a blood test to check for liver issues and that they should recheck the cholesterol levels at the next visit.
 
So at this point the patient concludes the following about the new medication:

     

  • The doctor never talks about cholesterol or brings up the subject of the medication. I assume I am taking it correctly.
  • If the doctor doesn’t mention it (the medication) it must not be important.
  • I haven’t notice any difference in my health – I guess I don’t need the medication.

 
Sure the patient should have asked their doctor if they had any questions about the new medication. But patients seldom ask their doctor questions. Sure they could ask the pharmacist…but the pharmacist would tell them to just ask their doctor.
 
It so much easier for the patient to just not refill the prescription.
 
We have all heard the expression that whatever doesn’t get measured doesn’t get done.  Well the same thing is true for when it comes to physician-patient communications.  Whatever issues doctors don’t talk with patients about will not get done over the long haul either.  In this case patient’s simply stop taking prescribed medications.
 
As primary care slowly shifts from episodic, acute care to continuous care with the aid of EMRs and the focus of patient-centered care things should get better with respect to patient compliance. It needs to. Give the current focus on episodic acute care too many chronic health issues simply are not being addressed for one visit to the next.
 
That’s what I think. What’s your opinion?