Tuesday, September 13, 2011

When patients cheat

All of us know that patients don't always follow the doctor's advice. ( There's actually a fancy technical term for this, called non-compliance . This smacks of paternalism because it implies that the patient's job is to comply with the doctor's orders !)

We will often modify the advise, to suit our own lifestyle ; or tweak it, based on our personal beliefs. That's reality , and the sooner we accept this the better. I don't think it's ever possible to be 100% compliant with the doctor's orders , because it’s not possible for a doctor to factor in every patient’s personal limitations when devising a treatment plan. Patients often feel very guilty when the don’t obey their doctor’s orders – and their spouses will often give them a very hard time when they “ cheat “ and don’t listen to their doctor’s advise.

Rather than try to ensure 100% compliance, which will never be possible, I think this is a major opportunity for advancing medical knowledge. The trouble is that when patients cheat, they often don't share this information with the doctor because they are worried that the doctor may get upset because they did not follow his orders. This means that when the patient goes back to the doctor , the doctor naively assumes that he has been following his orders properly.

Now if the patient improves without taking the doctor’s medicines , but does not tell the doctor the truth, the poor doctor is going to continue thinking that the improvement was because of the prescription he wrote ! This is unfortunate , because a major teaching and learning opportunity has been lost. If a patient improves , every good doctor wants to know why the improvement took place , and what the patient did, so that he can learn from this experience and share it with other patients. The lesson is simple. If you do get better , inspite of ignoring the doctor’s advise and flushing his medications down the toilet, please let the doctor know. It's only when patients share information with their doctors that medical science advances.

A lot of discoveries in medicine are purely fortuitous - and are based on patients being honest and forthright with the doctor. One of the best examples is the discovery of Viagra which was originally introduced for treating men with ischemic heart disease. Researchers noticed that patients refused to return their extra leftover medicines . It’s only when they drilled down deeper and spoke to the patients that they realized that one of the pleasant side effects of Viagra was an improved and enhanced erection ! There must be so many other opportunities for learning from patients which we're losing on, because patients aren't willing to tell their doctors the truth that they did not follow their advise.

Please don't be scared to let your doctor know what you didn't follow his instructions ! Your doctor is on your side , and is happy to learn from your experiences !



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