When patients don’t follow their doctor’s orders, the results can be disastrous on a personal level, but also for the healthcare system. In the US, an estimated $300 billion is wasted because patients do not follow prescribed treatments, which results in increased emergency visits and longer hospital stays. A new study shows that the problem is much deeper than originally imagined. Funded by the Patient-Centered Outcomes Research Institute, it has found that 49% of patients do not follow recommendations and treatments prescribed by doctors, for two main reasons: a lack of patient input or feedback during visits, and unclear written communications given to patients by their doctor.
Patients’ Preferences are Ignored
The study revealed that one of the most important problems facing patients currently, is the lack of informed choice. Researchers noted: “Physicians often do not elicit patients’ preferences or discuss reasons not to take action.” They stated that there are specific instances in which communication between doctor and patient is lacking.
For instance, 32% of patients report not having talked to their doctor about all the different medications they have been taking over the past 12 months. Some skip doses or stop taking medication because of side effects or because they feel medication is inefficient. Around 27% of these patients do not discuss these problems with their doctor. Of those who stop medication because of cost, meanwhile, around 39% do not mention the problem to their doctor. By speaking to their doctor about their problems with medication, they can be prescribed a lower priced or alternative drug that ensures their health condition is kept under check.
Disagreement on Diabetes Management
Taking diabetes as an example, the above-mentioned study reveals the extent to which medication affects the production of insulin, and can have side-effects which should be the subject of discussion between patient and doctor. It was noted that patients and doctors often are at disagreement regarding diabetes management goals and strategies. Clearly, more care needs to be taken to ensure patients can relay any complaints, concerns, or treatment preferences they may have.
Why is Patient Recollection so Poor?
A lack of patient input is one thing; poor recollection of instructions relayed by one’s doctor is another. The reasons postulated by researchers for the latter is that consultations are often disorganized and short, lasting 15 minutes on average. Listening to patients is key if doctors are to make better decisions.
The researchers suggested that doctors should encourage questions and rely on methods such as ‘teach back’, in which the patient is asked “to repeat the information in his or her own words. Doctors should also provide information that is structured in the form of a ‘table of contents’ followed by ‘chapter headings’, in order to improve recall. Finally, the amount of information given in a single visit should be limited, to enhance patients’ ability to remember the content of the visit.
There has been little development in the way doctors and patients communicate in the past few decades, and clearly, the result is miscommunication and confusion for patients. Greater care needs to be taken in each visit, and it all begins with listening. An accurate diagnosis and treatment cannot be given without understanding the full nature of each patient’s problem.