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Patient Compliance

Doctor examining skin for skin cancer

Patient compliance refers to how well a patient follows their doctor’s prescribed treatment plan. It’s often understated but very important when it comes to obtaining satisfactory results.

The rate of compliance varies depending on the condition and the patient. I’ll use a common example from my own practice. Let’s say a mother is more concerned about her son’s acne than he is. When they return home after the appointment, the son may follow the prescribed treatment only when pestered by his mother. Acne requires a long-term treatment, and the treatment won’t work unless it’s used regularly. Because the son has poor compliance, his acne doesn’t improve and both are left frustrated.

In contrast, a person who has a rash or skin irritation that makes them itchy and miserable is more likely to have a higher rate of compliance. This is because they’re motivated to seek immediate relief, and their prescription requires effort for a limited amount of time. But if a person has a chronic rash, like psoriasis, in areas not cosmetically bothersome, they may decide the effort required to maintain long-term results just isn’t worth it.

Given the variability with compliance and its importance to successful results, I believe there are steps doctors can take to increase patient compliance. These are strategies I follow in my own practice.

Explain more. Whenever I prescribe a treatment or medication, I explain expectations, how to use the medication, and possible side affects. In acne treatments for example, I’ve found compliance improves if a patient understands it may take several months before seeing results.

Affordable medications. If a patient can only afford a partial prescription, they won’t obtain the results they need. I like to have an open discussion with my patients regarding medication costs.

Reasonable regime. I do everything I can to make treatment plans with as few steps as possible. A once per day treatment has a much higher compliance rate than 3 times per day.

Understanding why. I believe doctors have an obligation to “sell” the message so patients understand why we’re doing what we’re doing. In the care of a patient who has eczema, I will explain that using a moisturizer regularly protects the skin and helps it from breaking down, making it less susceptible to uncomfortable rashes and the need for harsher medications.

Tailor the message. My advice is to use language that’s appropriate to the patient. I have found that in casual conversations most people use language typical of a fourth grade level. If a patient doesn’t speak English I’ll ask them to return with someone who can translate.

These are things doctors can do. Patients can also be proactive in improving their compliance.

Open discussions. If you’re a parent bringing a child in for a long-term condition such as a chronic skin rash or acne, you should have a conversation with your child before setting an appointment. Use the conversation to make an honest evaluation of your child’s willingness to follow through with the treatment.

Establish a habit. If you need to apply a cream or take a pill, you need a strategy to make it part of your daily schedule. For instance, take a pill after you brush your teeth or apply cream after you shower.

These are suggestions specific for a doctor or a patient. In reality, it’s helpful to remember that your relationship with your doctor is a partnership. If you aren’t following a treatment plan, you and your doctor can look for reasons why it didn’t work. Perhaps it was too expensive, too irritating, or the treatment wasn’t long enough.

It’s your responsibility to understand, be on-board with your doctor’s strategy, and insist on clear communication. In my practice I provide information sheets to supplement many of my patient discussions and post information online. In the end, you and your doctor are working towards the same goal.

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