Mutual Matters

The Non-Adherent Patient

Posted by Bill Kanich, MD on Jan 26, 2017 1:00:00 PM

How to Approach Situations When Patients Don’t Follow Your Advice

MMIC_Upset_Patient-2.jpgMost physicians are familiar with patients who don’t always follow the advice given to them. For example, up to 30 percent of prescriptions are never filled, and another 30 percent are taken in an inconsistent matter. Providers often order tests or make recommendations and then may not be aware of whether or not the patient is following through. 

The term nonadherent may be used when describing patients who are unwilling or unable to follow the recommended treatment regimens.  Nonadherence is a challenge for the patient and the clinician and can occasionally present a liability risk.

How to have the discussion

Having frank discussions with patients and being non-judgmental can be an effective way to find out more about the patient’s perspective and reason for nonadherence.

Ask open-ended questions to explore the reasoning behind a patient’s nonadherence. Is the patient not convinced about what he or she needs to do? Or does the patient lack the confidence or ability to follow through? Patients are also likely to react more positively to treatment if they are involved in core decisions and if they understand that the advice given by their physician is personal, and not a one-size-fits-all solution to their particular health issue.

Patients should be made aware of resources available to help them follow treatment plans. Affordability is often a factor in nonadherence, especially now with many patients having high deductible insurance plans. Physicians should diplomatically ask patients if this might be an issue and can propose less expensive, but effective, alternatives. 

What to do when a patient is non-adherent

Recommendations on how you should respond and document a non-adherent patient are outlined below. While we don’t reasonably expect you to do these in all patients, your response should be commensurate with the risk involved in each patient’s situation. A patient with a suspicious mass may require all of these while an abnormal test with little risk of an adverse event may only require a chart note.

  1. Chart note—A note like “Colorectal cancer screening risk/benefit discussed,” during an annual exam is invaluable when defending allegations around such screenings. If you have a discussion exploring the reasons for nonadherence, include these reasons and what you talked about in the medical record.

Lack of patient compliance can put both the patient and the physician at risk. To see more of our recommendations on patient safety and non-adherent patients click the link below. 

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