Physicians Practice - March 2008 - (Page 81)

CME IN PRACTICE DO AS I SAY … PRETTY PLEASE? B Y S H E L LY K . S C H WA R T Z , B A YOU DIAGNOSE AND PRESCRIBE ALL DAY LONG. BUT IT’S ALL FOR NAUGHT WITH A NONCOMPLIANT PATIENT — AND SO MANY OF THEM ARE. WHAT CAN YOU DO? It should’ve been a simple procedure. Neil Baum, a urologist in New Orleans, recalls one instance when he inserted a ureteral stent to relieve a kidney obstruction in one of his patients. The patient then left the ofﬁce, after being told to return in three days time to have it removed. He never did, despite countless attempts to reach him by phone. An inevitable infection set in, at which point the patient began threatening legal action, blaming Baum’s standard of care. But Baum was prepared. “I showed him the consent form that clearly stated he had to return, along with our records showing he didn’t return our calls,” says the associate clinical professor at Tulane Medical School who estimates that up to a third of his patients don’t hear what he tells them in the exam room. “Patients are out of their comfort zones when it comes to healthcare,” he says. “It’s very stressful. They’re LEARNING OBJECTIVES After reading this article, readers will be able to: • Anticipate the reasons patients fail to comply with a physician’s prescribed treatment. higher rate of patient compliance. • Implement strategies to encourage a • Employ questioning and other communication techniques that can elicit better understanding and more compliant patient behavior. often anxious or frightened and not fully focused on listening to what you tell them.” Such is the quandary facing physicians in all specialties: You spend inordinate time and energy educating yourselves on the latest medical therapies, and yet all too often you’re stopped by patient noncompliance. “There are volumes of research in this area, but most studies ﬁnd that patient noncompliance with taking medication is roughly 50 percent,” says Jacqueline Dunbar-Jacob, dean of the University of Pittsburg School of Nursing, who has investigated patient adherence for 25 years. “Where lifestyle changes are recommended, that figure is probably higher.” WHY DON’T THEY LISTEN? There are countless reasons why patients ignore healthcare advice. Older patients, in particular, may believe the treatment will be ineffective, or they worry about unknown side effects. Or, says Dunbar-Jacob, they may simply forget. “The ‘forgetting’ phenomenon seems to be a real one,” she says. “The person who gets into the routine of taking medication every morning becomes so habitual that they don’t notice if they’ve missed it on any given day.” Sometimes noncompliance is purely a ﬁnancial issue, as some patients — particularly those on ﬁxed incomes — may not be able to afford the out-of-pocket cost of what you’ve ordered. What can you do to help mitigate this problem? “A lot of times the recommendations for a speciﬁc lab test or treatment may be fairly expensive and if it’s not covered by their insurance they may not have it done,” says Jim MARCH 2008 | PHYSICIANS PRACTICE | WWW.PHYSICIANSPRACTICE.COM 81 http://WWW.PHYSICIANSPRACTICE.COM

Table of Contents Feed for the Digital Edition of Physicians Practice - March 2008

Physicians Practice - March 2008 Contents The Bigger Picture: Try a Little Tenderness Second Opinion Letters Physicians Practice Pearls: The Value of First Impressions Noteworthy Cover Story: Your Complete Guide to Patient Service Billings & Collections: Rules to Code By The Administrators Desk: Selecting an EMR Technology: Learn to Love Your Nerd Ask The Experts Coding The Guide The Tech Doctor: All About Blogs The Great Practice Makeover: When Bad Things Happen to Good Practices Start It Up - NEW! The Law: Audits 101 In Practice: Do As I Say... Pretty Please? Healthonomics: Handling the Changes Wrought by Medicare D Classifieds Advertiser Index

Physicians Practice - March 2008

For optimal viewing of this digital publication, please enable JavaScript and then refresh the page. If you would like to try to load the digital publication without using Flash Player detection, please click here.