January 23, 2012

When patients don’t follow doctor’s orders, is it simply all their fault?

Maybe not, says dermatologist Steven R. Feldman.

Even while compliance and adherence to therapy is critical, data show that many dermatology patients don’t even fill their prescriptions, Dr. Feldman said during his presentation at the Orlando Dermatology Aesthetic and Clinical Conference.

Photo courtesy Wikimedia Commons/Alexander P. Kapp/Creative Commons License

But physicians shouldn’t put all the blame on the patients, said Dr. Feldman, director of the Psoriasis and Skin Treatment Center at Wake Forest University, Winston-Salem, N.C. Rather, they need to play a more active role and even use some tricks to get their patients motivated.

And it all starts at the front desk.

Take a look at the flyers and notices posted in the reception area, he said. For instance, replace that yellow sign about copays and insurance with one that says something like: “Our practice continues to grow through referrals from our patients. Thank you for your trust and confidence.”

Also, work on your bedside manner, even if it’s not your strong suit. Sit down with your patients, examine them carefully, ask them questions and address psychological issues. Establish a relationship with them, advised Dr. Feldman.

And try to get the patients involved in taking their medications. Give them written instructions. For children, use sticker calendars. Add a one-week follow-up visit, instead of waiting for a month. And put a twist on some of the side effects: “This drug is a diuretic. In addition to its effect on your face, you may also notice some weight loss,” or “It stings, but that means it’s working,” he said.

For nonadherent patients, use physician-administered treatments, such as hospitalization, office application of treatment, or phototherapy.

And try to simplify the treatment regimen instead of making it more complicated, especially for younger patients.

So let’s end with a question Dr. Feldman posed to his audience:

“If one of your patients calls you an ‘uncaring jerk,’ what would you do?”

a. Waive her copay.

b. Waive all her charges.

c. Acknowledge things weren’t ideal, and explain to her that you’re trying and ask for her feedback.

d. Dismiss her from your practice.

e. Post on your website that the patient is a chronic complainer.

The majority of the audience at the conference answered C. (A few picked D.)

What are some of your tips to increase patient compliance and adherence? Share them here, or send me a message on Twitter @NaseemSMiller. I’ll add them to this post.

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