Tuesday, 25 October 2016

Why is this Patient NON-COMPLIANT?!

Image result for physician and patient communicationWhat does it mean when we say that a patient is 'non-compliant' with his or her treatment plan? Usually, this refers to the fact that they are not following what they should be doing to manage their health conditions. Of course, we can see how frustrating this can be for healthcare professionals to deal with. After all, how can we make patients better if they aren't even doing what they should be?!

The issue, however, is much deeper than what appears on the surface. The key to working with a patient who is seemingly 'non-compliant' is to actually reframe the situation - and to understand that 'non-compliance' needs to be explored.

First, let's consider the fact that 'non-compliance' means that the patient is not doing what we told them to. Well, this alone is problematic! Patients need to be at the CENTRE of our care.

Therefore, if we prescribe them a treatment (this could be a medication, a lifestyle change, etc.), and they are not motivated or convinced to change or implement the intervention, they simply will not do it. To a healthcare worker, this may seem like noncompliance. But really, perhaps the patient did not understand the plan properly. Or maybe there are barriers that are preventing them from following the advice, such as financial issues, lack of motivation, no social support, underlying medical or psychiatric issues, etc. If we don't explore these further, we will simply mislabel patients as being noncompliant - and then no one benefits.
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Another thing to remember is that noncompliance can stem from frustration or previous experiences. Let's say your patient needs to start a certain medication, but they have heard from others that this pill gives them so many side effects and trouble. Are they likely to take it? Probably not. Or what if the patient previously tried something similar and it did not work, and now they have lost hope. Again, we may immediately brush this off as being noncompliant. But without exploring these issues with patients, we will never be able to understand their experiences, opinions, and values. Thus, we will never be able to provide truly effective, safe, and compassionate patient care.

Image result for open communication healthcare quoteAt the same time, patients need to be open with their physicians. It is important for patients to let their doctors, nurses, etc. know WHY they are hesitant to follow their treatment plan, including any challenges that they are experiencing. This can be hard, as patients may feel embarrassed, they might not 'want to talk about their problems', or they might feel that this is not 'important'. However, open communication between patients and their healthcare providers is CRITICAL! It is only through these discussions that we can formulate a plan that works best for our individual, unique patients.

So, in theory, the term noncompliance really shouldn't even be used. It is not that the patient is 'not compliant', as this indicates that the healthcare provider alone is dictating what treatments should be followed; in reality, the regime is decided upon and discussed between the patient AND the healthcare team. Furthermore, noncompliance indicates an underlying issue of some sort, and needs to be explored further to determine what the TRUE factors are. Finally, open communication, honesty, and respect are the only ways through which therapeutic relationships can be established between patients and their providers, and through this, we can ensure that our interventions are patient-cantered and lead to positive health outcomes - a benefit for patients and their physicians!

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