Healthy Relationship Increases Patient Compliance
by Dr. Richard Drucker, B.S., M.S., N.D., Ph.D.
As a health-care provider, our primary challenge is to get our patients to follow specific nutritional and supplemental recommendations and protocols we feel will provide them with maximum benefits. As we all are aware, this task is often more difficult than it first appears. In fact, to support this, a task force found that compliance rates are only in the 30% to 60% range for common chronic conditions.1 Patients have the same compliance problems with prescription medications. One study revealed that one-third of the monitored patients took all their medicine; one-third took some of their medicine; and one-third never filled their prescriptions.2 Compliance is challenging in both the allopathic medicine and naturopathic fields.
Patients generally fall into two broad categories. There are those who prefer to be very limited in their decision-making involvement. These patients primarily tend to be older, possibly in poor health, and trust the health-care provider as the schooled and respected authority. This patient type almost always will take whatever is recommended. The second type is the patient who prefers to be actively involved in making decisions regarding health care and nutritional choices and treatment. These patients, who generally are younger and better educated, or who may have been actively self-managing a chronic illness for some years, tend to be less satisfied with their health care.3 They rely on the wealth of available printed and internet health material to educate themselves before they meet with their health-care providers and search out various doctors and/or make decisions regarding their own care.
In order to achieve better over-all compliance, health-care providers use various techniques, mindsets, and terminology to help their patients. The second type of patients requires this unique approach, so that they can see the benefits in following an established protocol. Rather than use the term compliance, which refers to an involuntary act of submission to authority, health-care practitioners have adopted the word "adherence" as a better description. Adherence is a voluntary act of subscribing to a point of view—it reflects a different viewpoint for patients to follow recommendations and, therefore, requires a more unique approach. Because adherence focuses on the voluntary act, others factors may make the protocol plan more difficult. Some of the factors are:
• Forgetfulness (forgetting how or when to take a supplement)
• Detoxification reactions
• Unreal expectations, such as expecting a quick fix or cure
• Individual personality
• Difficulty in swallowing pills or capsules
• Few or no presenting symptoms
• Lack of or slow results
• Poor protocol instruction
• Confusing or complicated regimen
• Physical sensitivities and tolerances
On the flip side, adherence can be more effective when one perceives that a particular need or desire will be met by following specific nutritional recommendations. A patient must be ready for care in order to be more compliant or adherent. Since most clients in the alternative health care arena do have a need and, thus, are seeking a solution, there is an advantage when recommending supplements.
When it comes to nutrition, additional factors that help to increase a patient’s adherence include over-all knowledge of the product—the ingredients, its effectiveness, their tolerance, and how others with similar health concerns have benefitted, the history of the product and manufacturer, proper and simple protocol instructions, and that the results outweigh the cost. Much of this is relative to the patient's desire to get better.
Keeping in mind the second type of patient who has done research and searched for his/her health-care professional, one of the most effective ways to reinforce adherence is through a beneficial health-care provider/patient relationship. Good communication between the two is extremely important. In this relationship, factors that may come into play are age, habits, convenience, desire to get well, and money. Modern health communication warrants that health-care providers do not ignore statements from their patients about their health and related factors, but that they trust them.
Part of the initial consultation, when setting up a course of action for treatment, involves asking the patient what other sources he/she has consulted for information about their condition and what other medicines or supplements they have taken for it. From there, the health-care provider can help them make better sense by directing the patient to the information and supplements they require to help them best. Patients are the best source of information about themselves. It has been shown that, if the patient’s own words and language can be used whenever possible, this will increase patient satisfaction significantly with their health visit or consultation.4 You need to work with the patient to:
• Determine the patient's expectations and definitions
• Confirm what information you need from the patient
• Acknowledge differences and similarities in values or points of view
• Encourage problem-solving
• Empathize with the current situation
• Recognize any difficulties or complaints
• Agree on a diagnosis and course of action, including which particular supplements are to be used
• Be open minded to new ideas and treatment modalities
The risk of a patient quitting a long-term treatment grows greater when that treatment stabilizes a condition, rather than relieves the symptoms. If this stabilization occurs, the health-care provider should go over the patient’s history and review their original complaints. Often, a patient will forget the severity of the initial symptoms and a review helps to emphasize the improvement they have made and the importance of continuing a prescribed course of treatment. Prevention is better than treatment.
Occasionally, a patient will experience detoxification reactions when they begin to receive the good nutrition that has been lacking for so long. If the client does not expect that kind of reaction, they may respond negatively and discontinue the treatment plan. Adherence in nutritional supplementation also improves when the supplements are easy to take, are complete and few in number, and are in a form that is easily swallowed and digested, as in an organic liquid form that tastes good. Clear and easy-to-remember instructions on how to take the product is important as well.
If a health-care provider already has a working relationship with a patient, they know from previous care how eager he/she is to participate in decision making and self-care. However, if the patient is new and the health-care provider is unsure, the best approach is to ask. This way, the patient's expectation for involvement may be better understood, and their particular nutritional needs will enable the health-care provider to better modify his or her approach. Over time, the adherence approach will help to build stronger relationships with patients, increasing their loyalty to the health-care provider and to their practice.
Dr. Drucker has a Master’s of Science in Natural Health and a Doctorate in Naturopathy. He is a highly respected doctor in the field of natural health and the CEO of Drucker Labs, which manufactures and distributes health, wellness and nutritional products. These products use a breakthrough technology called intraCELL™ V, which yields unique carbon-bond organic microcomplexed structures that are highly bio-available and extremely effective. You may contact Dr. Drucker at 866-693-4810.
Nelson, AM, Wood, SD, Brown, S, Bronkesh, S with Gerbarg, Z. Improving Patient Satisfaction Now: How To Earn Patient and Payer Loyalty. 1997. Gaithersburg, MD: Aspen Publishers, Inc.
Hayes, R.B.NCPIE Prescription Month, October 1989
Anderson, LL, DeVellis, RF, Boyles, B, Feussner, JR. Patients' perceptions of their clinical interactions: Development of the multidimensional desire for control scales. Health Education Research. 1989;4(3):383-397.
Rowland-Morin, PA, Verbal communication skills and patient satisfaction: A study of doctor-patient interviews. Evaluation & The Health Professions. 1990;13(2):168-185