Patients sometimes get frustrated with lack of improvement in their condition. They try a treatment, perhaps not trying it very well, see that it isn’t working and get more frustrated. They begin to get the sense that treatments don’t work, so they use those treatments ever less well. By the time they see you, they are almost dismissive that anything you recommend will help them. And, in a self-fulfilling prophecy, there’s a good chance that anything you recommend won’t work because of their poor adherence to treatment.
Presenting patients with another treatment that “might help” may not encourage the patient to use the medication well. However, some much needed cheerleading may help break the vicious cycle of poor adherence & poor results. Being upbeat and confident about the recommended treatment can help build the patients’ confidence in and use of the treatment. Along with the cheerleading, the presentation of high expectations for the treatment, it helps to tell the patient that “this treatment works fast” and that “we’ll see you in just a few days or talk by phone so you can report the progress.”
The expectation that the treatment will work fast will encourage the patient to use the medication. The short time horizon until the next communication with the doctor is another powerful incentive that drives patients to use their medication better (as discussed in a previous blog). These short term measures are powerful tools to improve adherence in patients who don’t use medications because they don’t think medications are going to work.
—Dr. Steven Feldman is a professor of dermatology and public health sciences at Wake Forest Baptist Medical Center in Winston-Salem, NC, where he studies patients’ adherence to treatment. He is also Chief Science Officer of Causa Research, an adherence solutions company, founder of www.DrScore.com and author of “Compartments”.
