Learning From Patient Noncompliance
These tips were found in Learning From Patient Noncompliance by Lili Church, MD (Fam Med 2000;32(1):11-2.)
The author suggests several issues to review whenever a patient is noncompliant. While the original focus seems to have been on training residents, there is much that could be useful in any physician’s practice. I’m especially taken with these three points:
1. Remember that they are the patient[s], not you
Although it’s a shibboleth and one that applies to many areas of healthcare as well as noncompliance, it’s nonetheless important to keep in mind the dangers of the clinician viewing the patient’s noncompliance as a personal affront.
2. Work with the patient to focus and identify what they do want to do. Encourage them to make a choice and try that. (Even no choice can be viewed as a choice.)
The author’s point is that egosyntonic recommendations are more likely to produce positive results than are confrontations about what the patient is doing wrong or not doing.
3. Regularly ask patients, “So, What Worked? What Do You Think Made the Difference?”
There are two benefits to this tip:
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1. It’s a reminder that it’s obvious that clinicians should routinely ask their patients “What worked?” or “What have you tried that hasn’t worked?” Just as obviously, most of us don’t ask unless spurred on by a specific reason (e.g., a dramatic improvement or deterioration in the patient’s condition).
2. The phrasing is respectful to the patient, is an inquiry instead of an accusation, and aligns the patient and the clinician in a mutual task.
CME: Treatment Nonadherence Among Individuals With Schizophrenia: Risk Factors and Strategies for Improvement »
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