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Getting the 'Straight-A' Patient<
by: Theresa Defino
Today's patients are better informed about their health than ever before. Or at least they think they are. That may be why some of them don't follow your directions — and why you need to be a better teacher. It's dark and temperatures hover at zero, but Thomas Kottke, MD, is undaunted. Unless the roads are too icy, the 57-year-old cardiologist is bundled up and out of his house before 7 a.m. each workday, biking the first leg of a 14-mile roundtrip to his St. Paul office. The owner of five bikes, Kottke has regularly engaged in this type of exercise his entire adult life. He says he does so not only for his health, but also to be a good role model for his patients. "Clearly, 'Do as I say, and not as I do' doesn't play very well with patients," he says. So when Kottke tells a patient recovering from a heart attack that he must get regular exercise, he's not about to accept Minnesota's harsh weather as an excuse. Kottke doesn't expect patients to duplicate his dedication. But his years in practice — and those he spent serving on the American Heart Association's (AHA) national patient compliance taskforce — have taught him that every bit of persuasion helps. "I search for something that they used to do, that they used to enjoy," Kottke says of his patients. "Many people used to swim or run or bike. They don't have to try to be world-class; that just causes injuries. I point out to them that the biggest benefit they can get is really to go from doing nothing to doing something." Kottke has enjoyed success with his approach of tailoring his instructions and suggestions to the lifestyles of individual patients. That was one recommendation of the AHA's taskforce, which concluded that a combination of techniques can best enhance patient compliance. They advise to learn — as Kottke does — what might motivate individual patients and then deal with the preconceptions they may have about certain treatments. Consider ways to simplify regimens. Repeat your suggestions and get patient buy-in, similar to how a salesman would close a deal. Finally, don't let today's "empowered" patients overpower you. Yes, you can negotiate treatment plans and discuss options with your patients. But you're the one who went to medical school. Help your patients make sense of all the information they've gotten, but feel secure in your recommendations. Why the big deal? Patient noncompliance is a significant problem in healthcare delivery. Up to half of all patients fail to follow their prescribed drug regimen; some 5 percent to 20 percent of prescriptions are never filled in the first place. Patient compliance with protocols for coronary artery disease and other chronic illnesses continues to be poor. A study by researchers at Duke University published in the Jan. 2006 issue of Circulation found that in 2002, just 39 percent of some 30,000 patients with coronary artery disease consistently followed their physicians' recommendations for taking aspirin, beta-blockers, and lipid-lowering medications. Adherence levels were only slightly higher than those reported in 1995 among the same group of study subjects. Lead researcher Kristin Newby called "eye-opening" the finding that only 71 percent of the patients studied regularly took aspirin, despite the fact that it is cheap and readily available. Clinical outcomes for patients who follow recommended protocols are understandably better than for those who don't. But more than your patients' health is at stake if they are not compliant with your directions, says Manoj Pawar, MD, the medical director for Denver-based Exempla, a nonprofit physician network. You'll make more money in pay-for-performance programs if you can demonstrate that your patients are compliant in receiving preventive care su< |
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