If you diligently heed your doctor’s advice, you may be surprised to learn you’re in the minority. According to CNN, patient noncompliance is an epidemic. It is estimated that 20 to 30 percent of short-term therapies, 50 to 60 percent of long-term medications, and 70 to 80 percent of lifestyle advice goes ignored. Over 50 percent of prescriptions written each year are either taken incorrectly or not at all.
Kerry Hendershot, MD, a board-certified family medicine physician at Covenant Medical Group, shares insights drawn from his years of practice as to why patients often ignore or don’t follow their doctor’s advice.
Q. Are there certain types of conditions where people have more difficulty following their doctor’s advice?
A: Health issues that don’t present immediate, visible threats to the patient’s health are often easy to ignore. Smoking cessation is, of course, especially hard for some people to achieve even though the risks of smoking are well known. People who smoke get used to the coughing and push it to the back of their mind.
I tell patients every day to maintain a healthy weight, eat right and exercise to reduce their risk of heart disease. But even with people who are visibly obese, it’s something they often don’t address until the symptoms—like high blood pressure and high cholesterol—show up. People have a tendency to put things off until they can’t ignore them anymore, even when it affects their health. Also, it’s just plain hard to stop eating junk food when our bodies have gotten used to all the sugar and salt. By the same token, it’s just as difficult to get out there and work up a sweat a couple of times a week when we’re used to a sedentary lifestyle.
A big part of my job is to continually encourage my patients and remind them of the importance of prevention. Preventative health care may seem like common sense, however, most people need a gentle reminder from a trusted doctor.
Q: Why is it still difficult to convince smokers to quit after years of outreach?
A. Nicotine is notoriously addictive. Fortunately, I have seen a marked decrease in patients with nicotine addiction thanks to the stop-smoking movement. When I do see patients that want to quit, I advise them about a variety of therapies, methods and medications that may be right for them. One of the more effective motivational-based ways I’ve seen that helps people quit smoking is a reward system. There are even phone apps that can help track the number of smoke-free days and money you’ve saved. The reward is using the money to buy yourself something nice.
It’s important to realize that smoking cessation has a strong psychological component, and that is the reason why many people do not follow through on medical advice or treatment. Unless the person is committed to changing their lifestyle, they will not be able to quit.
The patients I see tend to use smoking as a coping mechanism for stress, so they are not immediately inclined to give tobacco up--they need it to relax. It is especially troubling to see young people, like those ages 14 to 18, who are addicted to cigarettes, despite all the smoking laws. But, if I can get a young person to quit smoking before they are 21, the likelihood of them returning to smoking is significantly diminished. Older and middle-aged people are the hardest to convince. They tend to be set in their ways and can have a hard time committing to changing their habits. I understand how they feel, and I develop rapport to help them move forward.
Q. Obesity has become a serious health problem for many Americans. Are patients taking your diet and exercise recommendations seriously?
A. I’d say it’s mixed results. Again, there often has to be a motivational factor such as poor health or diagnosis of a related health problem. The truth is, many people do not have the necessary motivation to lose weight; they have to be willing and committed to changing their lifestyle. Patient education on my part can help provide that motivation.
I counsel every patient who has an elevated BMI (body mass index) on how to eat a more balanced, healthy diet. I recommend eating a variety of fruits, vegetables, lean meats, whole grains and limited snacks. Medical therapies are also available for people in need of additional weight loss help. Here in Texas, we also place particular emphasis on portion control, because we are a culture that likes Texas-size portions that fill our plate from edge to edge.
As for exercise, I recommend 150 minutes per week. Patients can break that up however they want across seven days. Some people feel intimidated by the gym and resist this recommendation. However, exercise can be done anywhere, and a little cardio goes a long way. For those unwilling to go to a gym, I recommend movement that can be anything from a brisk walk, jog, hike or swim a few times a week.
If I see weight loss at their next appointment, I make sure to compliment their efforts. I’ve been practicing medicine for over 20 years, and I’ve come to realize you shouldn’t underestimate the power of positive reinforcement. You’d be surprised how far a well-placed compliment can go for someone struggling with their weight.
Q. Prescription medication is important for everything from treating infections to controlling chronic conditions like diabetes and heart disease. Why do some people forego taking the drugs their doctor has prescribed?
A. First and foremost is cost. Affordability of care is a real problem in America, and insurance companies sometimes do not cover the prescribed medications, or only a portion of them. Unfortunately, a lot of people do not follow through with prescription medications because they can’t pay for them out-of-pocket. If the cost is too high, many people will go without the medication they need to avoid sacrificing something else.
For example, obesity is a growing problem in communities with limited resources, partly because fast foods are less expensive than fresh, healthier foods, so people with little money may end up eating far too much junk simply because that’s all the can afford. For these people, a $50 out-of-pocket cost for medicine is typically a financial burden. There are excellent medications available as part of a medically-supervised weight loss program, and we should make them more accessible, especially in underserved and vulnerable communities. It’s an example of the crisis in access and affordability of care that’s a major health challenge across the country.
Q. Do you think the internet makes patients skeptical of doctor advice?
A. The internet is a blessing and a curse when it comes to health information. Some patients come to my office already knowing what is wrong with them and the treatment they need–and you can’t tell them any different. While it is true that patients are more knowledgeable about their health and ask a lot more questions about treatment options, I want each patient to have the knowledge they need to make the evidence-based health decisions that are right for them.
Oftentimes online medical advice can be incorrect or even harmful, depending on the source. Patients can’t and shouldn’t try to diagnose themselves. If patients are going to be skeptical of the advice of a trained, experienced physician, they should be far more skeptical of health information posted on a forum or found on random websites.
Millennials, as I mentioned earlier, are the most empowered patients I have treated. Instead of what used to be the traditional doctor-patient relationship, where the doctor gave advice and the patient simply followed it, they want an expert guide to help them achieve their health goals. The bottom line is that, regardless of what’s available online, everyone needs a trusted physician as their partner in health. The stronger and more trusted a relationship is between a doctor and patient, the more likely the doctor’s advice will be followed.
This information is not intended as a substitute for professional medical care. Always follow your health care professional's instructions.