A large proportion of patients with chronic diseases often find it difficult to follow long-term treatment, as it requires consistency and full compliance daily, alongside their social life, activities, etc.
Causes of non – compliance can also be the inability to understand the treatment, as well as its importance.
Within this framework, the great challenge faced by health professionals is highlighted, starting from diagnosis, suggestion of appropriate treatment and support of patients with the ultimate goal of compliance.
“Medicine is not just a science, but also an art,” the Renaissance physician and philosopher Paracelsus once said. “The character of the doctor can act more forcefully on the patient than the drugs used.”
This observation was made 600 years ago, but it still applies to primary care physicians, particularly when it comes to helping their patients manage the condition.
A doctor can understand the science behind treatments for diabetes or hypertension.
However, this knowledge is not enough when the patient refuses or does not fully comply with the treatment to be received and that is where the “art of medicine” comes in.
Chronic diseases: a growing problem
The need for patient adherence to treatment regimens has never been greater as chronic diseases become more prevalent.
According to data from the Centers for Disease Control and Prevention, in 2018 nearly 52% of adults had at least one of the 10 most diagnosed chronic conditions, while about 27% of adults had multiple chronic conditions.
This is up from 22% in 2001.
Similarly, studies, conducted in 2022 found that mortality rates involving several common chronic diseases, including cardiac, chronic lower respiratory diseases, diabetes, chronic liver disease and kidney disease, increased from 2020 to 2021.
At the same time, several problems such as the limited time of an appointment, the rising cost of prescription drugs and patients whose insurance coverage is insufficient for their health needs, prevent doctors from providing the necessary information and support to their patients for better compliance.
All this, in addition to the challenge of persuading patients to change their lifelong behaviors that may have caused or worsened the disease in the first place.
Helping patients understand the disease and its management
Faced with these difficulties, the question arises: how can primary care physicians best help patients adhere to a treatment regimen to manage their chronic disease or condition?
Doctors experienced in treating such patients say the first important step is to ensure that the patient understands the pathology, how and why it should be treated.
The treatment plan and the possible consequences of non-compliance should therefore be explained to the patient.
Explaining to them why they should take medications or follow a particular diet for their benefit, your reason should be simple, approachable, and understandpossible objections.
Sometimes a patient’s lack of understanding of what is required to adhere to a treatment is characterized by a willingness to cooperate and please the doctor.
Other patients are happy to accept treatment, saying, “Yes, I can do it.”
Then, when they get home and the daily routine begins, they really understand what it entails to follow the treatment and the effort they must put into being consistent.
Building long – term relationships
In addition to educating the patient, it is vital to establish a lasting relationship, experts point out.
This not only builds trust, but often reveals clues as to what motivates the patient, a critical part of tackling chronic conditions.
This relationship allows the physician to also understand the obstacles the patient faces in complying and improving their health.
You can, for example, recommend a healthier diet, but if you think the patient does not have access to nutritious foods, you will you have to ask, “Is this the goal for something you think you could do?
If not, what would stop you? “, investigating the reasons/problems for not following the recommendation.
Another action could be to let patients set the agenda for the visit, in terms of what they see as their purpose and expectations for it.
This provides important information about the patient’s daily life, such as whether and how much they smoke or drink, whether they are sexually active, what kind of work they do and whether it exposes them to health risks.
All this may sound time-consuming, but it is important to have a patient-centered treatment, exploring as much as possible their habits, beliefs, etc. and generally anything that may affect their compliance.
If you don’t, you’ll miss out on what motivates the patient to make real changes in their lives.
Building such relationships may not be easy during a short date, but it is possible.
If a patient comes for a 20-minute drug follow-up or annual appointment, it’s harder to form a relationship right away.
It will take a period of years before the patient feels comfortable enough to tell you that they are only taking one prescription drug (which requires participation) once a day instead of 3 times because they can’t afford it.
What we call the “art” of medicine becomes much easier when a long-term relationship develops
The ability to “read” a patient and recognize the style and language of communication they respond to best is also part of the art of medicine.
To be successful regarding the patient (compliance) requires the ability to act ‘paternally’ with certain patients, which means that sometimes one will make decisions for them and sometimes one will be more fraternal, taking decisions together.
Doctors who are good at patient care can reverse these roles depending on what works best for each patient.
What motivates the patient?
Another benefit that comes from developing long-term relationships with patients is revealing what they value and enjoy in life – key to developing a treatment plan that the patient will follow long – term.
The example of a patient whose love of reading motivates him to comply with diabetes treatment.
In this case, the importance of controlling the condition is emphasized, as it may affect vision due to retinopathy of the macula often caused by diabetes.
Many times, a doctor faces significant difficulties when it comes to changing patient behavior.
For example, convincing sun -worshipping skin cancer patients to reduce their exposure to sunlight is a real challenge.
The doctor should learn as much as he can about a patient to find out what is important to him and use the information as a motivational tool.
When you ask many of your elderly patients, the answer often shows a desire to remain physically active.
Once you understand what motivates them, the reasons for avoiding intense sun exposure, for example, can be put in this context.
Dedication to the treatment plan
Revealing the patient’s goals is just the beginning and after that, it is important to regularly remind them what to do.
One can talk about the importance of applying sunscreen, but the big challenge is getting them to use it when they get up, every day and if they continue to be exposed to the sun, the challenge is to mitigate the effects.
The technique that often works for patients in making a major lifestyle or diet change is to break down into what we call “achievable portions.”
If a patient needs to lose a lot of weight, instead of immediately presenting it as a necessity, you can start by saying, “Let’s see if we can get to the point where you won’t be gaining weight anymore,” and then: “Let’s see how we can get to the goal so you can lose weight. “You have a few pounds.”
This way it doesn’t seem like an overwhelming change, but it happens more gradually, with the patient reacting positively, saying, “yes, I can try it.”
It has been shown that this tactic is much more effective than either telling them or simply telling them that they need to lose 150 pounds.
Like many other doctors who help patients cope with compliance challenges, it is vital to seek the help of family members, especially spouses.
This is usually the person with whom the patient spends the most time.
So, if the patient needs to stop smoking or cut back on alcohol or whatever, seek the support of the spouse, this makes the change much easier for the patient.
Conversely, lack of support can make desired behavior change more difficult, if not impossible.
If, for example, the husband has a heart problem and the wife is the one who deals exclusively with cooking, then if she is not informed about the healthy eating plan, it will not happen.
Needs a team
Another important factor contributing to successful compliance is the support and care provided to patients by the team.
Defining distinct roles for healthcare team members, assisted by additional counselling or monitoring, will greatly enhance compliance.
A team member who can spend time advising patients gives the opportunity to identify any social or financial barriers to compliance patients may be facing.
By motivating team members to engage with patients, you ensure a fundamental part of chronic disease management. Being close to the team with the patients creates a relationship of trust, leading to the exchange of views, understanding and ultimately improved compliance.
Meeting the cost challenge
The inability to afford prescription drugs poses another obstacle to compliance.
Not only are the prices of many drugs rising, but patients are paying more out of pocket for them.
The problem is compounded by the reluctance of some patients to admit that they cannot afford
their medications.
They feel like they’re saying, “I’ m not successful enough in life to afford these prescriptions,” and it’s embarrassing for them to admit it.
Doctors today are much more conscious and informed about the cost of medicines.
In such cases, you should look for solutions, such as asking the drug company if it has assistance programs for which the patient qualifies.
However, despite help with prescription costs and all the other types of compliance support that doctors can offer, some patients are reluctant or unable to follow a treatment.
When this happens, it’s important not to get discouraged.
You must understand that some patients are not going to change.
