Blog | Thursday, December 13, 2012

Poor adherence, non-compliance; should we label patients?


Almost 30 years ago I had pneumonoccal pneumonia. My symptoms were classic--seeming viral infection, then a drenching night sweat and a rigor, then a productive cough. My CXR should segmental consolidation.

My physician first put me on erythromycin, but we switched to Pen VK after I had severe nausea and vomiting with the 5th dose of erythromycin.

It took me 13 days to take all the penicillin. Taking medications 4 times a day is extremely difficult. I was poorly adherent.

A few years ago I had one toenail with a fungal infection. I took terbinafine daily, and only took 92 days to take my 90 pills.

Danielle Ofri has written a very insightful piece on labeling patients as non-compliant, When the Patient is 'Non-compliant'.

When we see patients in the hospital, or in clinic, and the patient does not comply with our wishes, then what should we do?

We must ask why the patient is not taking meds or dieting or stopping alcohol consumption. We have a responsibility to not give up on the patient.

Try, try again. Try to understand the patient, diagnose the patient as well as diagnosing the underlying diseases. Sometimes the problem is financial. Sometimes the patient has side-effects. Sometimes the patient just does not understand.

But we must not give up on the patient.

db is the nickname for Robert M. Centor, MD, FACP. db stands both for Dr. Bob and da boss. He is an academic general internist at the University of Alabama School of Medicine, and is the Associate Dean for the Huntsville Regional Medical Campus of UASOM. He also serves as a frequent ward attending at the Birmingham VA Hospital. This post originally appeared at his blog, db's Medical Rants.