What to do When Patients Won’t Follow Doctor’s Orders?

By Nancy Wurtzel

Patient noncompliance is a huge source of frustration for health care professionals.  After all, clinicians spend time and energy creating a care plan, only to be thwarted because patients won’t adhere to the prescribed treatment.  This patient behavior often leaves physicians feeling baffled and even downright angry.

Consumer Reports published a survey of 660 primary care physicians, “What Doctors Wish Their Patients Knew.”  The most common complaint was patients not following the doctors’ advice or otherwise adhering to treatment plans, including taking medications.

In fact, medications are well-documented as a top source of patient noncompliance.

Clinicians write upwards of 3.8 billion prescriptions annually in the U.S.  A study published by the FDA and the National Council on Patient Information concluded 14-21 percent of patients never even fill their original prescription, and 60 percent cannot name all the medications they are taking.  Equally disturbing is that 30-50 percent of patients consistently fail to follow medication regimens.

Failure to take medications as prescribed can translate into real health and financial consequences.  Poor medication compliance accounts for 33%-69% of hospitalizations due to drug-related adverse events.  Up to 40 percent of nursing home admissions are linked to poor compliance to medicine regimens.

Even more disturbing is that medication noncompliance is implicated in over 125,000 US deaths per year.

“Non-adherence with medications and treatment plans is a significant problem for patients, particularly those with multiple chronic illnesses, many of which require lifelong treatment to improve health outcomes,” said Dr. Peter Gonzales, an internist and primary care doctor at Beth Israel Deaconess Medical Center in Boston.

With so much at stake regarding health and money, this noncompliance has become an enormous challenge for physicians.

The reasons behind patient noncompliance are sometimes straightforward, such as a lack of funds to obtain a prescription.  Or those reasons could be as complicated as a patient being averse to taking any prescription medications.

Other patients may have good intentions, but taking various meds three or four times a day is too complicated, and they simply forget. The elderly or disabled may experience trouble administering medications. Many patients report side effects are an obstacle to completing a course of medication, so they cease taking them.

Those who have chronic diseases and are taking meds on a long-term basis may feel the drugs have done their job or have lost their potency.  Consequently, this belief might lead them to discontinue their med use.  Another issue lies with patients who self-medicate by adding contraindicated meds or supplements to their treatment plan.