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How Physicians Can Communicate to Increase Patient Adherence


Successfully communicating with noncompliant patients is one of the most difficult tasks physicians face. Strategic communication can help. Here are some tips.

You've all faced them - patients who just won't comply. At times, it can seem impossible to get them to listen. But believe it or not, the communication skills you employ might help.

Here are tips from three communication experts to help you strategically communicate with your noncompliant patients.

Listen (and watch) attentively. Often, the root of noncompliance is misunderstanding, says pediatrician Elizabeth Rider, an assistant professor of pediatrics at Harvard Medical School. Patients may not understand your directions, or they may have a misconception about the medication, treatment, etc. "It's equally important for the physician to understand the patient's perspective," she notes.

For example, Rider, who is also director of academic programs at the Institute for Professionalism and Ethical Practice at the Boston Children's Hospital and director of programs for communication skills at the John D. Stoeckle Center for Primary Care Innovation at Massachusetts General Hospital, says a parent might look skeptical when her child is prescribed a medication.

Rather than ignoring the patient or parent's reaction, "I will address it right away," says Rider. That way the parent has the opportunity to express her concerns from the beginning. For instance, a parent might share, "My grandmother took that medication and it hurt this or that." Once the parent's viewpoint is discussed and understood, Rider says she can often alleviate her concerns before she leaves the office. This increases the likelihood that the parent will follow her child's treatment plan.

"You have to really understand a patient's perspective, be open to that communication, and hear the underlying messages, whether verbal or nonverbal, that the patient has given you," she says.

Ask open-ended questions. Don't forget that external factors may prevent a patient from adhering to the treatment plan that you both agreed would be best, says palliative-care physician Marcia Levetown, a regional hospice medical director who teaches communication skills to physicians.

Perhaps the patient couldn't afford the medication, get a ride to the pharmacy, or reach the doctor to discuss distressing side effects, etc.

"We need to be less blameful and angry at patients and more open-minded to the idea that maybe there's good reasons [they were unable to carry out the treatment plan]," says Levetown. "Maybe, it was our own failure that led to treatment failure. If we see ourselves as partners with them it would be better."

When the treatment plan fails, ask open-ended questions to determine where the root of the problem lays, says Levetown. For instance, "We agreed the priority was this, and you were going to do that, and you were going to take this medicine three times a day. Did you run into any troubles with that plan?"

Get tough. If a patient simply refuses to comply with your recommendations, don't be afraid to impart some "tough love," says Jason Wolf, executive director of The Beryl Institute, an organization dedicated to improving the patient experience.

"Rather than continuing to bang your head against the wall and saying, 'This is what you need to do Mrs. Smith,' … it is a physician's willingness to say, 'I'm your physician and because of that sacred bond that we have, because of the oath that we took, I'm committed to your health and well-being. I'm committed to you getting better, and I have to be honest Mr. or Mrs. Jones, right now [your noncompliance] is in the way of your ability to do that, and so I need you to help me to figure out how to get beyond that," he says. "There's really nothing else you can do but show that level of tough compassion and be very clear about your intention and why you're sharing what you're sharing ..."

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