By Coverys Risk Management

Imagine yourself in the following situation:

It’s a typical Monday morning, and you’re reviewing the numerous reports and test results you received over the weekend. You are surprised to learn that one of your patients was hospitalized as the result of a stroke. Looking through your patient’s records, you recall that the patient had been seen the previous week with symptoms of dizziness and ear pain. At that time, the patient was given a prescription for prednisone, as you believed the patient was experiencing a second episode of vertigo. The patient's medical record also reflected your discussion about the risk of diabetics taking prednisone and the patient’s need to increase his insulin.

Knowing that the patient had a history of failing to follow instructions, you consider your recent care of the patient:

Did the patient understand the insulin dosing instructions?

Did the patient comply?

Could you have done anything further to reduce the risk of stroke or another negative outcome? 

A scenario like this can occur in any physician practice. When patients don't follow an agreed-upon treatment plan, it can have an adverse effect on the patient's health and on your ability to help the patient manage his or her care. Non-compliance is particularly serious when it comes to prescriptions. According to a 2012 article published by Health Leaders Media, up to 30% of prescriptions go unfilled and as much as 50% of medications for chronic disease are not taken as directed. When patients don’t take prescriptions as prescribed, their illnesses may get worse, and costs of medical care can skyrocket due to unnecessary testing and avoidable hospitalizations.

Why do patients fail to follow a treatment plan? Some reasons may include: 
  • Lack of understanding of the treatment, due to a language barrier or the use of medical terminology
  • Denial of the illness, especially if the illness doesn’t interfere with their daily life (e.g., high cholesterol or high blood pressure)
  • Inability to afford treatment, due to high co-pays or a lack of medical insurance
  • Difficulty following directions (e.g., “take medication every three hours”)
  • Fear of the anticipated side effects from treatment (e.g., pain from knee surgery) preventing the patient from agreeing to the treatment
  • Misunderstanding the importance of a treatment or the likelihood of its success
Promoting Compliance and Minimizing Risk 
Patients who fail to follow instructions or recommended treatment plans (by choice or accident/oversight) pose a risk to themselves and to you as their provider. How can you promote patient compliance and minimize that risk? The following strategies may be helpful:
  • Inform and encourage. Educate patients and family members about the patient’s medical condition or disease so they can effectively participate in the patient’s treatment and contribute to the patient’s healing process. Encourage patients to participate in developing their treatment plan to help them understand the reasons behind the plan, which may increase the likelihood that they will follow it. (See our blog article on shared decision making and patient engagement.)
  • Guide and listen. Provide clear instructions and ask for patient feedback to evaluate the patient’s interpretation and understanding. For instance, rather than telling a patient “to lose some weight,” consider providing a specific goal, such as losing 10 pounds by the next visit.
  • Spell it out … literally. Offer written instructions for patients to refer to later. Patients often don’t remember the verbal instructions they are given.
  • Empower. Establish guidelines for returning phone calls about prescription refills and lab results, and including patients in this process. For example, invite patients to call the office for lab results if they have not heard back from your office within a specified time frame.
  • Make it official. Obtain informed refusal from patients who admit they either can’t or won’t follow all or part of a proposed treatment plan. It is important to make sure that the patient’s medical record reflects these discussions, including the specific risks of choosing to forego a proposed treatment.
  • Chart it. Document all instructions and discussions held with the patient about a proposed treatment, including the patient’s response.
While patient non-compliance can pose challenges, you can help minimize risk of legal exposure while improving a patient’s health outcomes. Consider the many steps you can take to thoroughly educate your patients about the treatments you recommend and to create an environment of clear, encouraging communication that is as compassionate and engaging as it is practical and prudent.