Getting Patients
to Listen
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For most of us it is frustrating when patients do not follow our advice or instructions. We expect patient cooperation, when in fact there is strong evidence to the contrary. |
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This situation should improve, given the increased emphasis on patient education by manufacturers of eye care products and third party payers. Subscribers to eye care provider programs are empowered with information and self-help action to help them become better utilizers of the vision care services available to them. We must influence our patients to comply and adhere to the methods in order to improve patient satisfaction and insure successful outcomes to their cases.
Areas of concern for the eye care provider include instructions about contact lens care, i.e. wearing time, solutions and the need for follow up visits. Proper use of eyewear for designated vision tasks, like recommended care of the glasses, is another concern. Some experts claim that there are five basic key points required to accomplish ideal patient compliance. Whether we professionals like it or not, there is an approach practiced in other fields from which we can learn. We must first recognize the opportunity to help the non compliant patient. We can bend it to make it meaningful to the patient and indicate the necessary urgency for the patient to change his negative habits. Keep in mind that we are forming a partnership with the patient based on trust and understanding. In a sense, we are engaged in "selling" the patient on a set of ideas that not only will produce patient satisfaction but will also improve the doctor-patient relationship.
Reflecting the patient's own words whenever possible states that you understand the conditions and problems. Avoid the technical jargon and emphasize the patient's feelings. Researchers found that patients were less happy when doctors asked about technical topics and felt better when questioned about psychosocial topics. It is the language of feelings that seems to be the venue through which the doctors and patients can discover their common grounds. Case results are also improved through the language interaction. On the other hand, one study reveals that strong feelings expressed by the doctor had a positive effect on case results since the patients may have interpreted the doctors' reactions as a sign that they cared. This indicates that improved outcomes benefit the patients provided that they take the opportunity to explain their feelings, whether positive or negative.
It can be said that patient empowerment is based on adherence and not necessarily compliance. The patient is encouraged to become a decision maker and assume a share of the responsibility for managing his/her problem. The subject can be trained in self-care, goal setting, problem solving, stress management, coping, social support and motivation. Mutual respect is considered an important factor concerning doctor-patient rapport. Doctors are asking about patient preference regarding involvement in the decision making agenda. This is a key aspect in cultivating respect for the patient. Patients today vary in their desire to participate and interact with the doctor. There are patients who desire little or no involvement in the dialogue. Often, these patients are older and are satisfied with the traditional care they have been receiving. These patients are passive and tend to listen to the doctor and try to comply to the best of their ability. Other patients who fall into this category are those from other cultures in which it is considered disrespectful to ask questions or express concerns to an authority figure such as the doctor. They will require encouragement so that the professional can bring his expertise into their lives.
At the other end of the spectrum are the patients who seek to be involved in making decisions about their care. They are usually younger, better educated and tend to be less satisfied with the existing manner of health care. They utilize the vast amount of information from printed and electronic sources to form an intelligent base for their decision making. Some of the gathered information may be misleading or worse. Just as any good teacher would do, it is the professional's role to correct bad information.
Sometimes unexpected irritations can occur.
Examples are: The patient who desires an authoritarian doctor mismatches with a doctor who wishes to share decision making; the patient who requires a doctor who affords a parental role mismatched with the doctor whose role covers only the scientist's aspects of the case; the doctor who wishes to connect with the patient as a whole person, but the patient wants only to experience the technical know how. In those cases, mutual respect is hard to cultivate. It is important for the doctor and the patient to fulfill their roles and expectations. If the patient is new and the doctor is unfamiliar with the history, then it is recommended that the doctor should simply ask. In this way the doctor is better equipped to tailor an approach that would be best suited toward a successful conclusion of that respective case.
Eye care providers will find that adherence, instead of the failed expectations of the compliance mindset, will increase patient loyalty. Four suggestions are given to help establish adherence in your practice.
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Examine the patient's perspective: Listen for the patient's meanings, language and values as they respond to you. Make sure the technical language is reduced to terms that the patient will understand.
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Discover the patient's feelings: Listen carefully and react so that the patient is confident that you know how he/she feels about the matter under discussion. Demonstrate your own feelings, as well, about the discourse.
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Base goals on the patient's expectations: Encourage then patient to participate in the decision making as much as they are willing to do so. Guide the patient regarding realistic goals, steps to be taken and barriers that may exist that would hinder a successful self care regimen.
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Support the patient's education: Explore the different sources that the patient has examined and try to maintain the accuracy of that information and eliminate any errors that may exist.
According to a 2003 World Health Organization study, half of all chronically ill patients do not follow instructions about taking medication. This same group refuses to change their lifestyle habits in order to improve their health. A glaring complication has reared its ugly head. Patients who have lost their jobs, insurance coverage and have money problems will not seek care since they feel they cannot afford it. The doctors must face this challenge by supplying the information that will propel the patient to alter the harmful path he/she has been enduring and seek the more productive road of improved benefits. It is not an uncommon practice to refer this beleaguered patient to cooperative pharmaceutical or optical vendors and local and national government assistance programs.
All of us have encountered the patient who complains endlessly, yet will not adhere to our recommendations. The doctor must draw the boundary that exists between a merely difficult patient and one that is disruptive, abusive or belligerent. Patients who continually break appointments as "no shows" should be considered for termination. It is a rarity to discharge a patient. It is necessary, sometimes, to jolt them into reality and perhaps they will learn that negative behavior is a poor basis for doctor-patient relationships and accounts for the unsuccessful goals that result.
Discharging a patient is a last resort when attempts to ferret out the reasons for the disruption and non-compliance remain hidden. There are sample letters that are available from your liability insurance company to reduce the possibility of legal action from a discharged patient. This addresses the situation of doctor abandonment or discrimination. Records should indicate that the patient was warned of the consequences of continued non-compliant behavior. The letter of termination ought to be sent by certified mail with return receipt requested. It is important to give this patient sufficient time to respond to your warnings and the final notice of discharge. Check with your insurer or local society for help in this matter. Finally, refer the patient to the listings of other providers furnished by local or state organizations with the offer to transfer the patient records to the offices they have chosen. Written authorization should accompany the patient's request.
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