1. Health

Why Don't Patients Comply with (Adhere to) Treatment Recommendations?

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Updated January 16, 2012

When patients don't follow through with the treatment decisions they have made together with their physicians, it can cause additional problems.

They may not get over their sickness or injury. They may get even sicker or injure themselves further -- or worse.

Experts agree on these main reasons patients do not adhere to treatment plans (non-compliance or non-adherence):

  • Denial of the problem. Many diseases and conditions, in particular those that are asymptomatic (don't seem to have overt symptoms that bother the patient), are easy to ignore, even when they have been diagnosed. Patients with diabetes, or hypertension (high blood pressure), for example; because the symptoms don't get in the way of everyday life, it's easy for patients not to follow the prescribed treatment regimens. Non-compliance can, of course, have dire consequences.

  • The cost of the treatment. It may or may not be covered by insurance, and the more out-of-pocket cost to the patient, the less he is likely to adhere.

  • The difficulty of the regimen. Patients may have trouble following the directions. For example, taking a pill in the middle of the night, or simply opening the "child safe" container may create a barrier to compliance.

  • The unpleasant outcomes or side-effects of the treatment. Any perceived negative such as an unpleasant taste of a medicine, or the pain of physical therapy may keep the patient from following through.

  • Lack of trust. When patients don't buy in to the possibilities of success, they are less likely to follow through. In this case, they don't trust that adherence will really improve their health.

  • Apathy. When a patient doesn't realize the importance of the treatment, or doesn't care if the treatment works or not, he is less likely to comply.

  • Previous experience. Especially in the cases of chronic or repeat conditions, patients will sometimes decide that a treatment didn't work in the past, so they are either reluctant or unwilling to try it again.

There are additional reasons patients don't comply; regardless, when a treatment decision has been reached collaboratively, then patients need to follow through with those decisions.

If you find yourself tempted not to follow through on your treatment, then contact your doctor to share your reasons, and together, to the extent it's possible, work out an alternative you both can agree on.

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