Patient Compliance: Why Must It Be So Hard to Follow Doctors' Orders?

April 23, 2012

When it comes to patients taking your advice, sometimes it is easy, sometimes it is frustrating, and sometimes, it just won't happen.

I was doing rounds this morning and was sitting next to another physician who had to return a call to a patient. After he hung up, he rubbed his forehead and asked, “Why do we even bother giving patients instructions if they aren’t going to listen?” He said that he routinely gives patients a folder with written instructions as well as verbal instructions prior to their scheduled procedures, and way too frequently, patients don’t do as they are told. “You must have to deal with this all the time. How do you deal with it?” he asked.

“How” indeed. You just keep doing it, I guess. You make your recommendations, you dispense advice, you try to dismiss myths. You say the same thing over and over, hoping that someday it will be heard. You try to change tactics from time to time, hoping that by stirring things up, you’ll get through.

Some days, you get a little animated, even upset. At least, you do if you still care. I’ll admit I have gotten testy with patients, asking them why they even bother coming if they are going to ignore or worse argue with me. I usually pull myself together and apologize for getting snippy, and I explain that I get upset because I care. The same way I yell at my kids for doing unsafe things.

For some patients, I will admit, I have thrown in the towel. I tell them, they are adults, they can make choices. So long as they understand the consequences of their actions, there is nothing I can do. I have told them to diet, to exercise, to quit smoking, to take their meds, to have their tests done. I have told them that their actions can lead to complications, including things like heart attacks, dialysis, and death. If despite all that they will not listen, then so be it.

I will keep dispensing my advice. I’ll keep making recommendations. And every now and then, I’ll wonder why.

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