At Digital Doorway, Keith, a Registered Nurse working “with the Latino community in a New England city, caring for individuals with HIV/AIDS, diabetes, addiction, and sundry illnesses related to lives rife with trauma and the intergenerational effects of poverty,” has posted “Of Course I Take My Meds!,” in which he relates a simple patient compliance scenario, one surely re-enacted in a multitude of forms hundreds of times each day in various healthcare settings.
Nothing dramatic takes place. A patient complains that her asthma has worsened. Alert to the likelihood that the patient may not have taken her medications as prescribed, thus provoking this exacerbation, Keith asks her “Which medicines have you been taking?” She steadfastly claims to have followed her dosing schedule. A quick check of refill dates and a cell phone call to the pharmacy, however, reveals that the patient has not refilled any prescription in the past six months. The patient admits as much, attributing it to the cost of the pills. After a bit of encouragement and counseling, the patient, the story implies, agrees to resume taking the medication.
Commentary
As I’ve noted, there is little drama here. And, in fact, I don’t believe that every patient will respond positively, as this patient did, to rather straightforward confrontation on her noncompliance.
The key messages from this vignette, however, are helpful:
- Maintain vigilance for noncompliance as a potential cause of suboptimal outcomes
- Know the patient and the approach to which he or she best responds: In this case, the patient responded to low-level confrontation plus taking her hand and ending with a hug.
- Be persistent; Keith didn’t stop investigating simply because of the patient’s denial
- Look at the data (e.g., prescription refills, the pills themselves, the pharmacy records, reports from family members, etc)
- Go the extra mile; Did I mention that Keith was visiting the patient in her own home?
- Be realistic: the penultimate line of the story is “I remind myself to pay this patient a visit in about thirty days and see what meds she hasn’t refilled yet.”
While the summary of the post is described as “a nurse’s best defense against burn-out,” I suggest that these qualities are invaluable for anyone dealing with patient noncompliance: Patience, persistence and a sense of humor