Do you follow doctor’s orders? Over half of people on chronic meds take them incorrectly, or not at all, with serious consequences.
If you’ve ever skipped a medication dose or decided against getting a costly prescription filled, you’re actually a fairly typical patient.
Many people don’t do what their healthcare provider advises, or not exactly. The annoyance this causes their doctors is the least of the fallout.
Patient non-compliance is a growing, world-wide phenomenon, which contributes hugely to keeping us sick and inflating healthcare costs.
Compliance and non-compliance
Patient compliance (or adherence) is the degree to which you follow medical advice.
Not doing so – non-compliance or non-adherence – ranges from forgetting to wear your compression stockings, to missing therapy sessions.
However, the main concern is with medication non-compliance: skipping doses, taking incorrect amounts, or discontinuing treatment altogether.
These staggering stats indicate the magnitude of the problem:
Over 50% of people on chronic medications take them incorrectly.
Many prescriptions never get filled. In the United States, around 20% of scripts don't reach a pharmacy.
Why don't we take our meds?
Non-compliance is more than patients being willful or careless: doctors are responsible too.
A poor doctor-patient relationship marked by lack of communication and trust is thought to be the primary cause; reluctance to pay for costly prescription medication comes a close second.
Patients may not fully understanding why they've had a medication prescibed, or the importance of adhering to an often complex regimen – which becomes increasingly complex as more drugs are added. This may be especially confusing for elderly patients with memory difficulties.
Being unprepared for unpleasant side effects is another common reason people discontinue treatment.
With the more “silent” conditions such as hypertension, symptoms, and consequently medication benefits, may not be obvious. With other conditions, drugs take several weeks before benefits are felt. Patients may feel there's no point to pills that don't make them feel better, and stop taking them.
Sometimes when patients do notice an improvement, they stop treatment because they feel "cured". This hampers treatment of mental illnesses such as major depression: to avoid relapse, patients need to stay on antidepressants many months after their mood lifts.
The impact of non-compliance
Not only does individual patient health suffer, but society at large is negatively affected.
Non-compliance means more people stay ill for longer, increasing the burden on healthcare systems. Where non-compliance involves failing to complete a course of antibiotics, it fuels development of drug-resistant bacteria. Multi-drug resistant TB is largely caused by patients failing to complete treatment courses, and is a major obstacle to defeating the disease.
Other notable examples of diseases with high non-compliance rates are diabetes, hypertension and asthma. In all of these serious conditions, non-compliance is the biggest factor for developing severe complications.
Improve your compliance
Develop good communication with your doctor. If you feel you can't talk freely and struggle to get satisfactory information, it's time to find a new physician.
Useful questions to ask:
What side effects can I expect?
How should I take my medication to maximise effectiveness and minimise side effects?
When will I know the medication is working?
I can't notice the treatment is helping. Is it working?
Is there a cheaper alternative?
I don't like taking so many medications simultaneously. Can we reduce them?
I'm experiencing unpleasant side effects. Is it worthwhile continuing? Is there alternative treatment?
How often do I need checkups to monitor my progress?
Use a demarcated pill-box. This humble tool is invaluable for keeping track of medications.
Get support. Inform your partner, family and trusted friends of your treatment plan for the added benefit of their reminders and encouragement.
- Olivia Rose-Innes, Health24, February 2012
Have you ever disobeyed doctor's orders? Why? Post a comment below.
Wertheimer, A. and Santella, T. 2003. Medication compliance research: still so far to go. The Journal of Applied Research in Clinical and Experimental Therapeutics
World Health Organisation. 2003. Adherence to long-term therapies: evidence for action.