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Wouldn't it be great if patients followed doctors' orders and took their medications on time, stuck to their diets, and exercised more? Even though many of the reasons behind noncompliance are simple—like forgetting to take medications or just not being able to afford them—the solutions are not simple at all.
Kevin Marzo, MD
Chief of the division cardiology
Winthrop University Hospital
Some of the reasons for noncompliance are as simple as patients having a poor understanding of the medications and how to take them properly. Another problem is the affordability. The physician should spend time with both the patient and spouse or relative going through the medications, reconciling them with what the patient was taking beforehand, having the patient repeat instructions, and providing contact numbers in case they have coverage issues. The most important thing is a patient should have a good rapport with the physician. The patient has to feel like he's not being rushed out of the doctor's office. Modern-day information technology that can track when patients aren't filling medications can help physicians determine whether patients are unintentionally or intentionally being noncompliant. We really haven't used these types of advances yet in day-to-day management.
Alfred Sacchetti, MD
Chief of emergency services
Our Lady of Lourdes
The No. 1 reason a patient is non compliant is that the adverse effect of being noncompliant is not immediately apparent. If you're in your 30s and you're hypertensive, you don't get any of the complications of hypertension for decades. The simple answerto improve compliance is education. The problem is it's failed miserably. Unless there's some personal relationship to the adverse effects of a disease, providing literature doesn't seem to work. Partnering the person with someone who has the disease has had some success, but it's labor intense. I don't know anything short of negative reinforcement that's going to get people to be more compliant. Once a light goes on in someone's head that says, "I'm responsible for my health," they are extremely compliant. As long as patients have the mindset that someone else is responsible for them, you're fighting an uphill battle.
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