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Do As You're Told!

Posted Dec 16th, 2008 by Trisha Torrey

You’ve broken an arm, or you’re running a fever, or you’ve developed a rash. A visit to your doctor results in an order for a drug, a bandage or cast, surgery, or another treatment plan to help you heal or become healthy again.

Or maybe you have a chronic condition or disease, and you’re consistently under a doctor’s care.  At each visit, your doctor reviews your treatment plan and makes adjustments.  The goal is to help you manage your condition to improve or maintain your health.

In either case, your doctor did her job.  She developed a treatment plan.  If you handled your visit with her well, then you discussed her diagnosis and treatment, and asked questions to be sure her suggested approach was the right answer for you.

So what’s your job? 

Your job is to heal, or at least to keep yourself from getting sicker.  Your job is to follow the treatment plan provided by your doctor.

Sounds simple, right? In the perfect world, that’s exactly what we would do.

Remarkably, studies tell us that 50 to 75 percent of patients don’t follow their doctors’ treatment plan.  Either they don’t fill a prescription, or they don’t change a dressing, or they forget to take their pills, or they fail to follow instructions in some other way.  This failure to follow-through is called “non-compliance” or “non-adherence,” and doctors will tell you it’s their Number One complaint about patients. They ask, ‘If Mrs. Magillicutty came to see me because of her symptoms, then why doesn’t she take my recommendations seriously? Why did she waste my time and her money?”

Even more surprisingly, people with chronic problems such as high cholesterol, diabetes or hypertension have the highest non-compliance rates. They don’t “feel” sick, so they don’t take the drugs prescribed for them.  They fail to realize that by not complying with their treatment recommendation, they are simply setting themselves up to be sicker later.

Children, too, are often victims of caregivers who fail to follow a doctor’s instructions. Little Johnny has an ear infection, and Mom takes him to the doctor.  She may even fill the prescription for the antibiotic prescribed.  Then, because his fever subsides or because he’s well enough to return to school, she either stops insisting he take his dose, or just forgets all together.  Johnny often gets sick again, because he didn’t take enough of the antibiotic to completely kill the germs.  They simply got past the too-small amount he was given, and come back to rear their ugly sickness heads again.

 

Why Don’t Patients Comply With Treatment?

 

There are a handful of reasons patients don’t adhere to their doctors’ recommendations. Some make sense, even if they create new problems:

 

1.        If a drug or other treatment is too expensive, a patient may not pursue it at all.
This is particularly true for a patient who doesn’t have insurance.  In this is the case for you, talk first to your doctor or a nurse in your doctor’s office to see if there is a less expensive alternative. If your suggested treatment is a pharmaceutical drug, there may be a generic alternative. If you do have insurance, there may be a less expensive drug on a different tier of the insurer’s formulary.  Then, regardless of whether you can find an alternative drug, check here on PatientAssistance.com to find out if you can get help.

 

If the recommended treatment is for the use of crutches or setting up a humidifier, or another equipment-related solution, then look online or in the phone book for someone who rents or sells used medical equipment. 

 

If the treatment is a prescription that is just too expensive, regardless of whether it’s generic or a lower cost alternative, don’t just determine on your own not to take it, to take a smaller dose, or take it less frequently.  While those may eventually be alternatives for you, you’ll want to negotiate those decisions with someone in your doctor’s office.  They can provide the guidance for what will work, or what will simply cause you more problems.  You need to learn from an expert what all your alternatives are.

 

2.       If the drug or treatment has unpleasant side effects, the patient may stop treatment too soon.
When the doctor first prescribes any treatment, then it’s up to the patient to ask about possible side effects or contra-indications (meaning, conflicts with other drugs or supplements.)  If you suffer unpleasant side effects, and your doctor hasn’t already explained what to do if or when you experience them, then don’t just stop your treatment.  Here is what to do instead:

 

Contact your doctor’s office, and speak to someone who can help you better understand your treatment prescription.  You’ll learn whether those side effects are expected, and you can decide together what your options are.  You may learn that the side effects are worth the trouble because your outcomes will be so much improved.  Or you may learn that you are having some sort of reaction that requires you stop the treatment.  In either case, it’s up to you and your doctor, or your doctor’s designated person, to figure that out together.

 

3.       Some patients simply forget to take their medicine.
Yes, this is a form of non-compliance, too, even though it’s not intentional. 

 

Some drugs need to be taken immediately upon discovery a dose has been missed.  Other drugs don’t require you to make up that dose.  Many babies have been born to women who forgot to take their birth-control pills!  Other problems crop up for drugs that have been missed, even when missing that dose was a simple mistake. 

 

Make sure you know what to do if that happens to you.  If you forget to take a dose of a prescribed drug, you’ll want to check the written instructions that were enclosed with the drug to find out what to do, check online at the drug’s website, ask your pharmacist what to do, or call your doctor’s office to ask. 

 

Your doctor spent many years in medical school, and has experience to guide her treatment decisions.  She doesn’t make recommendations to improve her own health; she makes them to improve yours.  By not complying with her plan, you may be putting yourself at a disadvantage.  Even if you can cite one of the reasons above, you need to have a conversation with a medical professional to arrive at an answer that will work for you.

Being a wise patient includes the understanding that following your doctor’s orders usually means a better chance of healing or regaining your health.  Do yourself a favor by following her advice.

 

About the author

Trisha Torrey is Every Patient's Advocate. She is a newspaper columnist, radio talk show host, national speaker, and the guide to patient empowerment at About.com.

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