More on the Mystery of Nonadherent Patients
Today I had an encounter that left me feeling a bit unsettled. Last week I wrote about noncompliance, and today I found myself again meeting my first patient of the day, only to find a 32-year-old with alerts slipped into his chart about noncompliance with his medications. He had come in for his 3-month checkup, for which he showed up for loyally 4 times a year, and he informed me that he still was not taking the 2 medications that had been prescribed to him over almost 2 years ago. According to his quarterly blood work, he had cholesterol and triglycerides that were through the roof, but as I looked over prior notes, he continued to either not fill his prescriptions or to refuse to take any of the pills if he did.
At first I thought maybe it was a coverage issue, or that possibly he lost the prescriptions, or maybe even there was some sort of mix-up at the pharmacy that was never sorted out. When that was not the case, I figured maybe it was a lack of understanding about the importance of taking a medication for a condition that may cause no symptoms until late in the disease, as is commonly the case.
After some questioning from both me and the doctor, the patient seemed to shut down and become annoyed. When asked why he was not taking his meds, he shrugged his shoulders. When diet or exercise was suggested as an alternative, or when I started explaining why the medications were necessary, even if he was young and felt fine, he simply laughed and shook his head.
After repeated patient education and insisting from the doctor, the patient agreed that he’d take the medications, even though we were doubtful based on his past. At the end of the day, I wondered why this man even came in for his appointments. Here was a man who was concerned enough about his health to come to the doctor faithfully every 3 months, who had his blood drawn multiple times a year, who was called each time with the abnormal results, and who was paying cash for each visit, but who was still not willing to take medications.
As discouraging as it may be, as students or clinicians, I suppose this type of common interaction should only motivate us all the more to reach out to our patients and continue to try and change their mind for the better about managing their health.