One of the mysteries of medicine in the 21st century is how people survive the onslaught of having to take so many drugs.

As a specialist, I review all of my new patients’ medication schedules. It is not uncommon for their drug list to be as long as two pages.

If their diseases don’t kill them, their drugs certainly would.

As I’ve gotten older and had to take my own medications, I have begun to realize that we are often asking the impossible of our patients.

Even the simplest of things, like trying to remember to take a second dose of antibiotics for minor illnesses, can become a challenge.

Life intrudes. We get busy, we start feeling better and, sure enough, the chances of us finishing our prescriptions become impossible.

Welcome to the world of compliance in medicine.

Difficult challenge

Studies have shown that compliance in medicine is one of the most difficult challenges our system faces. Reasons are complex.

The cost of prescription drugs is rising exponentially. Often, writing a prescription for a new medication to a family with limited resources is an exercise in futility.

Yet physicians often seem to think that if a patient doesn’t leave with a new prescription, the patient hasn’t gotten his or her money’s worth from a visit.

I often go to the other extreme and do what I can to reduce my patient’s medications.

Another reason for poor compliance is little understanding of what the drug is supposed to accomplish.

Simply sharing what we know about certain medicines — which may not be what the manufacturer says — often helps with compliance.

And, of course, difficult dosing schedules make it tough for patients.

Travel and vacation plans often aren’t anticipated. It is not uncommon for patients to leave medication behind or run out while traveling.

Language barriers and cultural differences are other factors.

But, ultimately, lifestyle choices are the biggest factors affecting patient compliance.

Unfortunately, many patients often choose to spend their limited income on items other than drugs. That may not be what is best for them.

So what should health care professionals do with patients who cannot comply with our recommendations?

Does a lack of compliance suggest a breach in the doctor-patient relationship?

If so, what should be the results of that breach?

Schools of thought

There are two schools of thought on this subject. Some physicians think that if a patient simply refuses to take medication, smokes incessantly and engages in other health-damaging activities, the patient is choosing his or her destiny — and is wasting the time and money of the health care system.

Doctors legally can — and do — “fire” their patients who refuse to heed advice and continue living unhealthy lifestyles.

Other physicians recognize that we are fallible and while we may wish our patients would do as they are asked, we acknowledge the difficulty.

Like Paul writes in Romans, we all know what we should do — it’s in the doing it that we fall short.

Physicians who fall in this camp find a common emotional and moral meeting ground with their patients.

Physicians who themselves have experienced major diseases may be more compassionate.

Many physicians take their relationship with patients seriously. For them, refusing to provide care for non-compliant patients is simply not a moral option.

Is there a right or wrong way to deal with this?

Probably not. But simply being aware of the limitations of patient compliance can be the first important step toward a new understanding of treatment options.

 

Michael Attas is a local doctor, a medical humanities professor and an Episcopal priest. Contact him at Michael_Attas@baylor.edu.