Danielle Ofri, M.D. has an interesting article on The New York Times “Doctors” health blog about doctors’ reactions to patients who don’t follow-through on their instructions:
As soon as a patient is described as noncompliant, it’s as though a black mark is branded on the chart. “This one’s trouble,” flashes into most doctors’ minds, even ones who don’t want to think that way about their patients. And like the child in school who is tagged early on as a troublemaker, the label can stick around forever.
Despite efforts to change the term to the slightly more accurate “nonadherent,” the word “noncompliant” remains firmly entrenched in the medical lexicon. No matter what it’s called, however, it’s an enormous problem. Experts estimate that some 50 percent of patients do not take their medicines as prescribed or follow doctors’ recommendations.
I guess physicians who care for adults have a harder time with compliance than pediatricians. Most kids usually need to take only one prescribed medicine at a time and only for the duration of a brief illness. Even when children are being treated for chronic conditions with long-term prescriptions, parents are more inclined to give their kids every possible benefit by complying with doctors’ orders. In fact, many adults I talk to freely deny themselves the fruits of good medical care while at the same time bestowing every benefit possible to their children.
But for many adults, it’s pretty complicated. Ofri gives an example of a theoretical 67 year-old man with diabetes, high blood pressure, and high cholesterol (a common combination in adult medicine), and how difficult complying with all the routine recommendations might be:
Besides obtaining five prescriptions and getting to the pharmacy to fill them (and that’s assuming no hassles with the insurance company, and that the patient actually has insurance), the patient would also be expected to cut down on salt and fat at each meal, exercise three or four times per week, make it to doctors’ appointments, get blood tests before each appointment, check blood sugar, get flu shots – on top of remembering to take the morning pills and then the evening pills each and every day.
Added up, that’s more than 3,000 behaviors to attend to, each year, to be truly adherent to all of the doctor’s recommendations. Viewed in that light, one can see how difficult it is for a patient to remain fully compliant.
Compliance can be a difficult balancing act for many, if not most, patients. The more complicated their medical history, the harder things become. Dr. Ofri argues that doctors need to be more understanding and compassionate about this problem.
Sometimes pediatricians are accused of coming on too hard with patients and families when it comes to the prevention of acute and chronic diseases. We seem to harp on immunizations and obesity and fitness and substance abuse and so many other, critical things. But there is a reason for our “madness.” We want your child to grow into a healthy adult with healthy habits for a healthy lifestyle.
In the second decade of the twenty-first century, it’s pretty clear what makes people sick and what can be done to keep people healthy. Focusing on prevention in childhood is our vital role as pediatricians.
As the saying goes: “If you don’t have your health, you’ve got nothing.” How true.
Read Dr. Ofri’s article here.