I saw a patient back yesterday who has suffered from a long standing and uncomfortable but not life threatening condition. It was very gratifying in that she was markedly better. However, the road to arriving at this more desirable place was a rather circuitous one. I had been treating her for more than one year before I became aware that she was less than fully compliant with my recommended treatments.
I know this first hand. I am very bad with medications. I was started on a lipid lowering agent a number of years ago and I know that I was very bad about taking it every day. However, more recently I have developed a bit of prostatism and an oral agent to treat has been instituted. If I don't take this, I get a relatively quick reminder that I failed to be compliant. I think my compliance with all my daily medications has improved.
The lesson I cam away with from this encounter was not that my patient was stupid or unreliable. It was that people are complex. Our brief encounters with them rarely allow us to begin to understand their motivations and fears. The lack of understanding cuts both ways. We are essentially strangers to our patients. They do not know who we are, what motivates us, and why we make the recommendations that we do. There has to be a huge element of trust for them to adopt our recommendations and it begs the question; Why should the individual in front of us at any given moment trust us? What have we done to gain their trust?