The Foundation of Treatment Adherence
Enhancing Patients’ Treatment Adherence
Doctors study for years to have the requisite skills to provide care for patients. We need to be expert in making the right diagnosis, and we need to prescribe the right treatment. That’s only the beginning. Providing the right diagnosis and the right treatment isn’t enough. We also have to get patients to use the treatment.
To do that, we have to make sure patients trust the treatment. This may be hard to believe, but patients don’t trust drug companies. The public doesn’t trust health insurers, either. Whether patients’ trust the recommended treatment or not is founded in their trust of their physicians.
Doctors need to engender trust and confidence. Patients base their satisfaction with and trust in their doctor on whether they feel they are seeing a caring doctor. Primary care providers may have long standing relationships with patients that promote this sense of caring and trustworthiness. But as we move toward digital record keeping and a more industrialized health care system, maintaining that sense of trust is becoming a greater challenge.
Doctors do care about their patients, but patients can only judge what they see. A doctor who appears rushed does not appear caring. So while I may run to the door of exam room to stay on time, I open the door slowly when I get there, making the patient feel like I am in no hurry. As a dermatologist, I may be able to tell what rash patients have from the door of the exam room (and what treatment they need), but patients need to know—from their perspective—that I did a thorough examination. So before I tell them what they have, I palpate the rash and examine (or at least pretend to examine) it with the biggest lighted magnifier I could find on eBay, then pronounce the diagnosis. I have a feeling that the whole purpose of laying the stethoscope on the patient’s chest and back is to achieve a similar effect; well, at least I feel I got a thorough examination from my gerontologist when she put her stethoscope on me (even though I don’t remember hearing anything of value when I used a stethoscope as a medical student).
We spent many years of study to make the right diagnosis and prescribe the right treatment. But when it comes to getting patients to use their medications, those years of study don’t matter much. The little things we do—touching patients, acknowledging their family, using their names, recognizing them as human beings—that patients see and that make us appear caring to them have big effects on patients’ adherence and treatment outcomes.
Dr. Steven Feldman is a professor of dermatology and public health sciences at Wake Forest Baptist Medical Center in Winston-Salem, NC, where he studies patients’ adherence to treatment. He is also Chief Science Officer of Causa Reseach, an adherence solutions company (www.causaresearch.com), founder of www.DrScore.com and author of “Compartments” (www.compartmentsbook.com). Contact him at email@example.com.