Communicating with patients may motivate them to adhere to prescribed treatment

Communicating with patients may motivate them to adhere to prescribed treatment Dr KK Aggarwal A new research reports that low-income patients with high blood pressure are less likely to take their medications as directed if their healthcare providers do not use a collaborative communication style or ask them about social issues. The three-month study published in the journal Circulation: Quality and Outcomes examined the impact of patient–provider communication on medication adherence among a sample of primary care providers and their patients who had hypertension. Most of the participants were black, unemployed and reported some college education. The study found that: • Patients were three times less likely to take their high BP medications when their providers did not possess a collaborative communication style such as asking open-ended questions and checking their understanding of instructions. • Patients were also six times less likely to take their medications as prescribed when a healthcare provider did not ask them about social issues such as employment, housing and partner relationships. This study demonstrates the negative impact of poor communication on adherence to treatment and highlights the need for better doctor-patient communication to improve compliance to treatment and achieve desired treatment outcomes. The study says that “such discussions signal to the patient genuine caring and concern by the doctor, which strengthens patient’s ability to cope with their life and illness, along with motivation and confidence related to self-management of their disease”. Listening is very important skill for doctors. The concerns of patients should be addressed without being judgemental. Therefore, in addition to prescribing medicine, doctors should also take note of the social determinants of health when managing their patients, as they have significant role to play in the health and wellbeing of the patient. Patients want support and encouragement to take their prescribed medications, especially in case of chronic illnesses such as hypertension, diabetes, heart disease, etc. They either often forget to take their medication or may not realize the need for adherence to treatment. Low income patients usually may not be well educated. This group of patients must be explained the need of compliance to the treatment prescribed. They have to be educated about the disease and why medication is important. This reassures the patient and he/she is motivated to follow your instructions more willingly. On the other hand, high income patients sometimes may be too busy to remember to take their medications. It may not be a priority for them, at that time. Adherence to medications in such high income patients can be improved by SMS reminders. As Sir William Osler famously said, “The good physician treats the disease; the great physician treats the patient who has the disease.” (Source: AHA News Release, August 22, 2017) Disclaimer: The views expressed in this write up are entirely my own.

Patients who trust their doctors are more likely to adhere to prescribed treatment

Patients who trust their doctors are more likely to adhere to prescribed treatment A new study of 101 Hispanics and 100 non-Hispanics from the University of California presented at the recent American Heart Association’s Quality of Care and Outcomes Research Scientific Sessions 2017 in Arlington, Virginia has shown that patients with high blood pressure who had more trust in the medical profession were more likely to take their high blood pressure medicine than those with less trust. • Patients who had higher levels of trust took their blood pressure medicine 93% of the time versus 82% of the time for those who had lower levels of trust. • Additionally, having trust in the medical profession was linked to greater resilience (ability to adapt to difficult life circumstances) and better health-related quality of life. • Trust had an equally protective effect on the health of both groups regardless of race or ethnic origin. The doctor-patient relationship is the foundation of the practice of medicine. It is a fiduciary relationship; fiduciary derives from the Latin word for "confidence" or "trust", which forms the basis of an effective doctor-patient relationship. Mutual trust is important for positive treatment outcomes as was shown in the above study. But, this trust is slowly eroding away and a doctor-patient relationship is no longer held sacrosanct as it once was. Lack of communication is a major cause of disputes between doctors and patients today. This can be tackled by the triad of ‘Plan, Communication and Documentation’, where ‘Plan’ means observations and treatment decided by the doctor and if the same is ‘Communicated’ to the patient, ‘Documented’ and then implemented, there can never be a dispute. Any disparity between your plan and the outcome leads to a dispute. A patient who does not trust his doctor will not confide in him nor will he be motivated to adhere to the prescribed treatment plan. Modern medicine today is patient-centric based on partnership, where the patient is an equal partner in the diagnostic and therapeutic process. Patients rely on doctors to take care of their health, so it is important that patients trust their doctors. Be courteous with the patients and explain the management plan in a language that they are able to understand. This is the concept of informed consent To build a successful doctor-patient relationship: • Do what you say: For example, if you have told your patient that you would be late by one hour, make sure that it is only one hour and not later than that • Document what you speak and • Preserve what you document Dr KK Aggarwal National President IMA & HCFI