Why patients don't want to follow doctors' prescriptions

Leonid Chebotansky, Olesya Sosnitskaya, Be Healthy magazine

To come to the doctor and not be treated – it would seem that it is completely illogical. But back in the immemorial times of historical materialism, when one of the authors of this article studied at the medical institute, a great "secret" was revealed to him at the Department of Social Hygiene concerning the unpredictable results of treatment – if medications do not help, check whether the patient took them.

Unpredictable results are when, in theory, the treatment was prescribed correctly and should have helped the patient, but for some reason it did not help. Why? But because very often patients themselves do not want to be treated.

The situation at the reception. An indignant person comes and declares: "Doctor, your treatment does not help me."

– Have you taken this medicine?

– Yes, I took the whole package.

– Wait, I gave you an appointment for ten days, but in the package only for five. You are holding an appointment in your hands, where it is written in black and white: "take 2 tablets in the morning and evening for 10 days."

In response, silence.

– Did you take this?

– Yes, only at the pharmacy they told me that there is an analogue three times cheaper, and I drank it.

Along the way, it turns out that two injections were made, not ten, because it hurts, and it is inconvenient to travel far and uncomfortable for physical procedures, respectively, they were not there either. When asked what he was doing at all, the patient proudly replies that he used ointment from the prescribed one and took one name of pills out of three, and also, on the advice of a neighbor, drank a decoction of unknown herbs and homeopathic pills found in relatives. Of course, the wrong treatment is to blame for the failure.

Do you think we're exaggerating? Alas, all this is from life.

Back in 1984, Italian psychologists Di Niccola and Di Matteo conducted large-scale research on how doctors' prescriptions are fulfilled. The statistics they received caused amazement: it turns out that in more than half of the cases, patients, even when they are very ill, do not take all or part of the prescribed medications, do not come to the procedures and do not follow other recommendations.

Now, according to practitioners, the percentage of people who do not comply with the prescriptions of attending physicians is even higher. Moreover, there are only more ways to reduce the effect of visiting a doctor to zero. If earlier it was possible to get a prescription and not walk to the pharmacy with it or take medications as God wills, in addition to violating the regime, now pharmacy consultants are at the service of unconscious patients, advising "almost the same thing, but cheaper", and the Internet with its thousand ways to "do even better than a doctor prescribed."

What makes patients behave like this? On the one hand, our own shortcomings are to blame: laziness, medical stupidity, belief in medical myths and irresponsibility, and on the other – lack of contact with a doctor and distrust of medicine.

Problems of doctor-patient relationshipIn order not to be accused of mutual responsibility of doctors and indiscriminate groaning of patients, let's first talk about the doctor's fault in the unwillingness of his patients to be treated.

People tend to fear the consequences of treatment more than the disease, do not believe in success or deny the severity of the disease in order not to panic. To protect yourself from stress, a person is prone to "running away" from the problem, especially if the disease is serious or incurable. And here it depends on the doctor whether he wants and can find an approach to a variety of people.

Moreover, the relationship between the effectiveness of treatment and trust in a particular specialist has long been beyond doubt – it has been noticed that the appointments of a family or respected doctor are performed much more accurately. The unfriendly attitude towards the patient and disregard for ethics on the part of doctors immediately causes internal protest and unwillingness to pay attention to the recommendations. And this protest can only be overcome by the patient's natural diligence or an unshakable belief that the doctor knows his job perfectly, although he is a cad.

That's just not to forget that most doctors in the existing health care system are forced laborers. They would be happy to conduct hour-long explanatory conversations with each patient, build bridges and look for an individual approach. But this idyll is also prevented from happening by the system that refuses an ordinary doctor in conditions for the normal performance of his own duties. After all, in practice (if we are talking about polyclinic admission), it is unrealistic to put the initial examination, filling out documentation and forming trusting relationships in the traditionally established standard of "8 minutes per patient".

The patient is not always rightIf we talk about patients, then laziness prevents them from being treated in the first place.

I'm too lazy to organize my time so that I don't forget to take medicine, go to procedures and sit in line. Others are turned away from treatment by the slightest difficulties: an inconvenient doctor's work schedule, the lack of medication in the nearest pharmacy and even a tight opening bottle (yes, it happens). Awareness of the fact that once you get sick, you need to make efforts to recover is not available to everyone. There are also cases when relatives refuse to treat the elderly, as it is troublesome, and they "have already outlived their time." Sometimes the patients themselves say that it is better to live with the disease, but without strain.

There is a category of people who, due to illiteracy, simply do not understand how to behave during an illness. They learned to read and write thanks to universal secondary education, but they did not learn the rules of hygiene, logic and other necessary things. As a result, the instructions are not read and are not carried out, even the most harmless side effects serve as a reason to cancel the drug (and the doctor is not informed about this, you'd think we don't take these pills, because we drink 3 more names regularly), and improvement is a reason to abandon treatment.

In addition, we must not forget that the disease is, at least, stress, and even serious physical suffering. And not all people in such a situation are able to think and act adequately. With painful long-term, or even lifelong treatment, almost any person has a desire to throw everything to hell. Without the understanding of the doctor and the support of the environment, it is easier for such patients to refuse treatment than to overcome difficulties. A well-known cardiologist Maxim Osipov wrote for good reason that "a man after 50 with heart failure, if his wife does not follow him, is doomed to an early death," and not because he is incurable – he simply will not be treated.

Semi-literate journalism and the love of mass media for simple and incorrect messages in the field of medicine contribute to the unwillingness to be treated normally. They gave rise to a bunch of medical myths and phobias, when a patient demands a miracle cure with one pill, the word "antibiotic" can scare children, doctors turn into pests in the patient's mind, and any appointment requires ten rechecks "in very reliable sources." For some reason, the latter mostly include acquaintances without medical education, popular articles and Ge Malakhov, broadcasting from the screen about the dangers of medicines and the benefits of herbal-infused kerosene.

A kind of medical illiteracy is also the installation "we are being treated while it is bad." Patients, as a rule, are ready to take medications only as long as unpleasant symptoms persist. Even in a hospital setting, after an average of 5-7 days without control from the staff, non-compliance with appointments begins. The reason here lies in psychology: after all, if there is an improvement, it is difficult to limit yourself in something and experience the inconvenience of observing the regime.

But the most important reason from which everything else stems is irresponsibility. After all, an untrustworthy specialist can be changed, misunderstood to ask again, the replacement of the drug should be coordinated not with the seller from the pharmacy kiosk, but with the attending physician. But it will never be done by someone who does not value their own health.

The harsh voice of statisticsLet's summarize the results.

According to research, in about 50% of cases of unexplained failures in normal treatment, the patient simply did not take medication or did it incorrectly. Another 25% are attributed to the failure to comply with other recommendations (diet, sleep regime, hygiene, stress, etc.). 12% are genetically and environmentally determined reasons (for example, the inability to change their place of residence with asthma). The reasons for 8% of unexplained failures in treatment are related to the medical service (here are medical errors, mistakes of nurses, and the absence of nurses and untimely ambulance arrivals, the quality of food in hospitals and the lack of hot water there, etc.). 5% is allocated to other, more rare reasons.

So it is often easy to find the culprit for the failure of adequately prescribed treatment by simply looking in the mirror. And alas, even if all doctors were attentive and friendly, they would explain in detail the reasons for prescribing a particular drug and possible side effects, half of the patients would still not follow their recommendations until they changed their attitude to health and treatment.

Portal "Eternal youth" www.vechnayamolodost.ru08.12.2008