Sunday, March 23, 2014

The noncompliant doctor

A lot has been written about patient compliance . Lots of doctors ( and pharmaceutical company executives) believe that if patients learn to be compliant and follow the doctor’s instructions , they will get better. Patients are expected to do what the doctor orders them to and doctors believe that patients will follow their instructions.

Interestingly, while the traditional  belief was that compliant patients did better than those who did not follow their doctor’s orders, we now know that noncompliant patients are of two different kinds . One doesn’t follow instructions because they cannot afford the prescribed medicines or are unable to understand the doctor’s complex instructions. However, there is a subset of noncompliant patients who actually do even better than compliant patients. They have a mind of their own and when they disagree with the doctor’s advise they will chart out their own path. These patients are not aggressive, but they are assertive, and will not blindly do whatever the doctor tells them to.

Just like most doctors expect patients to be compliant, most patients expect their doctors to be compliant as well ! When they request the doctor to prescribe antibiotics for their cold or order an X-ray for their back pain, they expect their doctor to acquiesce. A compliant doctor does what ever the patient asks him to. This is why pharmaceutical companies spend so much money on advertising branded drugs to the public – they know that most doctors will agree to do what their patient wants them to.  Now this does not mean that doctors are puppets in the hands of their patients. This fact just recognizes the reality that because it is much easier for them to comply, most doctors are not willing to take the time and trouble to explain to patients why their patient’s requests are wrong.

Most doctors are quite happy to be compliant because it’s so much easier to take the path of least resistance. Saying yes to the patient saves them a lot of time, so they can move on with seeing the next one.  It also keeps their patients happy , so why rock the boat by saying no ?

However, there is a subset of noncompliant doctors who are far better than compliant doctors. They take the time to think through and process the patient's request . When they think it is medically inappropriate , rather than just accept what the patient wants , they will push back , and explain to the patient why their request is flawed. They will offer an alternative solution to the patient, which they feel is better and more effective.

Sadly, most doctors don't have this kind of time to spend with the patient. Few have the energy or the inclination to argue with the patient – after all, taking the approach that the “customer is always right” is much easier ! However, this kind of doctor is a better doctor, because he makes sure that his patient gets the right amount of medical care - not too much , and not too little .

It is the noncompliant doctors who are the true professionals – they have the patient's best interests at heart . They respect their personal professional abilities , and would rather do what is right for the patient on a long term basis, rather than try to curry short term favour by keeping the patient happy . Few doctors have the self-confidence to do this. They are worried that if they do not agree with the patient's request,  the patient will go off to another doctor and he will lose his patients to someone else . He does not want to lose income , and will therefore buckle down to patient pressure ( much of which is created and cleverly manipulated by seductive advertising by pharmaceutical companies and medical devise manufacturers). 

By contrast, wise doctors have the maturity to understand that if they take the time to explain to their patients what the right course of action is , intelligent patients will appreciate their advise and efforts – and are likely to be far more loyal in the long run. Good doctors know that it is far better for them fire patients who have unrealistic demands and who do not value their professional opinion ! They understand how to talk to their patients,  and educate them, so they become smarter patients !

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