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At a community gathering we did a small circle of what brightened our week. A new participant, young and freckled, shared that she was a medical student. Her great moment of the week was when a teaching assistant who was also a student, four years their senior, gave a class and was kind. Not condescending. Not saying things like "that's not the topic," or "I already explained that." This magnificent TA made the budding med students feel like they were worthy individuals whose confusion wasn't a mark of stupidity.
How sad that this was rare enough to be treasured - it says a lot about medical education. Even sadder when you consider all the incidences where the modeling of how to relate to people who know less than you do will be necessary in a doctor-patient interaction.
Patients value their doctors' personality and demeanor as much as they value the medical care they receive - I learned this when I analyzed thank-you letters to medical centers. But don't make the mistake of thinking that how people are treated is just warm and fuzzy.
With 50% of patients non-adherent to medication, physicians cannot over-explain, and certainly cannot afford to say "I already explained that." What if the second, or third, explanation will help keep a patient on her antidepressants?
A study by Randy and Lori Sansone found that 50% of patients who are prescribed anti-depressants by a psychiatrist of general practitioner will go off them prematurely. This can lead to the depression recurring, and may result in suicidal thoughts. The Sansones say the non-adherence is due to patient factors, such as concerns about side effects, fears of addiction, and belief that these medications will not really address personal problems. It's also because of clinician factors, such as lack of sufficient patient education. When I look at these factors, it seems apparent that the patients need and deserve kind communication. They need and deserve the legitimacy to be confused, and to have their confusion resolved.
It will help their emotions, but also reduce non-adherence, re-admissions, and adverse events.
A 2018 study reports that non-adherence to chronic disease medications costs the USA $290 billion (USD) every year in avoidable health care costs. In Canada, it is estimated that 5.4% of all hospitalizations are due to medication non-adherence. Patients say they don't understand why they are receiving the medication, what it does, or how long they need to take it for.
A study of over 13,000 patients with high cholesterol, found that 10% never fill out their first prescription, and 53% (!) either skip doses, take too low a dosage, or stop taking the drug prematurely (I almost wrote immaturely, Freudian slip). This means they have higher LDL ('bad cholesterol' values), and a greater risk of emergency department visits, compared with the adherent ones.
So, instead of a doctor asking whether one can afford to provide this type of treatment, holding patients' hands, responding to their questions and alleviating their concerns, ask yourself whether you can afford not to.
References
Miron-Shatz, Talya, Stefan Becker, Franklin Zaromb, Alexander Mertens, and Avi Tsafrir. "“A Phenomenal Person and Doctor”: Thank You LLemstra, Mark, Chijioke Nwankwo, Yelena Bird, and John Moraros. "Primary nonadherence to chronic disease medications: a meta-analysis." Patient preference and adherence 12 (2018): 721.etters to Medical Care Providers." Interactive journal of medical research 6, no. 2 (2017): e22.
Sansone, Randy A., and Lori A. Sansone. "Antidepressant adherence: are patients taking their medications?." Innovations in Clinical Neuroscience 9, no. 5-6 (2012): 41.
Lee, Janet Shin, Geoffrey Joyce, and Jeffrey McCombs. "Outcomes associated with primary and secondary nonadherence to cholesterol medications." Am J Pharm Benefits 8, no. 2 (2016): 54-60.
