Wednesday, October 02, 2013

Doctors, patients and Gandhiji's three monkeys



I was invited to give a talk at Aravind EyeCare on improving patient compliance. Aravind  is a world leader in treating patients with cataracts ; and they wanted to learn more about what they can do to improve the number of patients who sign up for the surgery which they so obviously need.

Poor patient compliance is a big issue today. When a doctor gives patients instructions  ( do these tests and take these medicines ), the doctor expects blind obedience from the patient . After all, the doctor is the medical authority, and if the patient has come to him for his advise and is paying for it, isn't it logical to conclude that he will follow the advise given ?

In reality, patient compliance can be less than 50% - especially for patients with chronic illnesses. A lot of patients will not take the medicines which the doctor prescribes – and this is very frustrating for doctors. This is why most doctors think of their non-compliant patients as being one of the three monkeys in the picture. They start believing that patients who do not follow their orders are :

  • dumb , because they do not understand what's good for them; or
  • blind , because they do not understand the consequences of not listening to the doctor's orders ; or
  • deaf, because they don't seem to listen to anything which the doctor tells them, no matter how much time he's spent educating and counseling them.
Doctors will often get fed up and say – If the patient does not want to listen and wants to reduce their life span by ignoring what I tell them, then that's their problem – I have done my best !

Ironically , patients also believe that their doctors resemble these three monkeys !

They believe that doctors are :
  • deaf, because he refuses to listen to them;
  • blind, because he does not seem to care about or understand their feelings or preferences ; and
  • dumb, because he does not bother to explain or share information; and does not understand that he is speaking in a completely foreign tongue which they cannot comprehend
Both these worldviews  are valid – and this is tragic , because poor patient compliance is bad for both patients and doctors.

This is why it's important for doctors to engage with their patients and not treat them as monkeys who are going to blindly obey everything they tell them . Some doctors still treat patients as puppets , who will do everything they are told to do. This is not true , and patients need to be treated with respect and empathy . Good doctors are able to do this efficiently , so that their patient compliance rates are far better than those of other doctors .

Sadly , compliance is not something which most doctors track . Most are blissfully unaware of what a big problem this is . Every doctor believes he is exceptional – and most bad doctors are blind about their own defects. They happily continue to delude themselves that their patients will do to everything they tell them to !

This is why it's so important to develop tools which track whether patients are following their doctor's advise. This is where technology has such a big role to play !  Technology can allow us to monitor patient compliance – for example, by reminding patients to take their pills on time; and digitally recording when they have done so,

Expert patients can also help to improve patient compliance. They can share the strategies which they use personally to motivate themselves , so they they are able to comply with their doctor's instructions . Because they speak a language which patients understand, patients are likely to be far more compliant when told how to do what the doctor tells them to do by expert patients. Smart doctors tap into the expertise of their expert patients in order to improve compliance levels amongst their patients.

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