Why Make It Our Problem When A Patient Is Not Compliant?
Dermatologists go to great effort to educate themselves about the wide array of skin diseases and their treatment. We are fortunate to have so many good treatments now, such that the vast majority of patients we see can be offered highly effective treatments. Yet, patients often do not use the treatments as recommended and often do not improve like they should. Is that our problem?
If our goal is to get patients well, then yes, getting them to adhere to treatment is our problem. Perhaps an automobile manufacturer can reasonably put the blame on customers if their car fails because the oil was never changed; a better car manufacturer/dealer might go to some effort to make sure the oil changes get done. We might expect teachers, on the other hand, to motivate their students to study regularly and not just present the information in a teaching syllabus and hope that students do the homework.
We are more like teachers. Perhaps too often we behave like piano teachers who expect students to practice every day after telling students, “Here’s a prescription for your sheet music. Take it to the sheet music dispensary. I really have no idea how much it will cost you. Practice every day. Practicing may cause headaches, rash, or diarrhea. But practice every day. We don’t need weekly lessons. I’ll just see you back here at the recital in 2 to 3 months.” With an approach like this, can we really claim it is our patients’ fault and no fault of ours that they are not adherent to recommended treatments?
When we have a noncompliant patient, we make it our problem because we are devoted to our patients, we want to see them get well, and they will only get well if we get them to take the medication. We make it our problem because we have plenty of tools available to get people to use their medication better.1 We make it our problem because we should be doing more than we were taught to do to get patients to use their medications effectively.
Steven R. Feldman, MD, PhD
Chief Medical Editor
Dr Feldman is with the Center for Dermatology Research and the Departments of Dermatology, Pathology, and Public Health Sciences at Wake Forest University School of Medicine in Winston-Salem, NC.
1. Lewis DJ, Feldman SR. Practical Ways To Improve Patient Adherence. Scotts Valley, CA: CreateSpace; 2017. https://www.amazon.com/Practical-Ways-Improve-Patient-Adherence-ebook/dp/B078NKWPHZ/ref=tmm_kin_swatch_0?_encoding=UTF8&qid=&sr. Accessed June 21, 2018.