Looking after patients who won't look after themselves
Do doctors prefer patients to be “obedient”? Gavin Yamey is trying to come to a deeper understanding
There is nothing more frustrating in medicine than caring for “heartsink” patients who ignore all of our medical advice. We watch in horror as they refuse to take their life enhancing medicines and continue to adopt risky practices. Up to one fifth will never take their prescription to the pharmacist,1 up to a half will delay or omit doses,2 and many will never turn up at specialist outpatient clinics.3 Their behaviour contributes to their illness and premature death. It causes us irritation, confusion, sadness, and anger. Are we powerless to change this interaction with patients, or are there ways to break the impasse?
As doctors, we tend to like those patients who do what they are told. Such patients are “complying” with our advice. But this kind of paternalistic relationship is outdated and unhelpful. The patient's view of the world - based on experience, culture, family history, and personality -