Getting patients to follow their medical treatment involves doctors attending to all of their needs—which builds a bond of caring and trust.

Much of today’s medicine is reductionist and revolves around the biomedical model. To the greatest extent possible, we try to find patients’ specific biochemical abnormality and correct that abnormality with specific drug therapy. Addressing adherence is a very different kind of problem, one that involves very complex human behavior and is affected by every aspect of human psychology. Unlike much of the rest of medicine, adherence issues are the same kind of “people” issues that come up outside of medicine all the time—issues of choice, decision-making, and behavior.

In my June column, I discussed the many reasons why patients are non-adherent and asked what could we do to change this situation. But determining the best ways to improve adherence to medical treatments may not be the best starting place. Instead, we might start by asking, “What are the best ways to get people to do anything?” This opens us up to the depth of possibilities that have been explored by marketers, sales people, and psychologists, not to mention teachers, parents, spouses, and children.

The most critical element in getting anybody to do anything is the relationship between those two people. What gets a soldier to storm a beach? What gets a worker to work overtime to get a job done well? What gets a teenager to clean up their room? While any of these involve multi-factorial, complex motivations, relationships between people are key drivers of behavior.

Doctors not only write prescriptions, their relationship with their patients can have a huge impact on whether patients take the prescribed treatment. Patients will take medicines to please their doctor and their fears of the risks will depend on how much trust they have in their doctor. They may take medications simply because they don’t want to let their doctor down. Thus, the physician-patient relationship is at the core of achieving good adherence.

Quality medical care entails more than just making the right diagnosis and prescribing the right drug, it also involves creating a strong bond between patients and their doctors. Based on data I’ve collected through the www.DrScore.com physician rating/patient satisfaction website, the most critical factor— perhaps the only factor—for creating patient satisfaction and a strong physician-patient relationship involves making sure patients realize they are seeing a doctor that cares about them.

But simply being a caring doctor is not enough to make a patient confident in the relationship, as a perception may be determined before that patient even sees the doctor. Was the person who took the initial scheduling call from the patient friendly? Was parking at the office accessible? Was the waiting room clean? Was the reception desk inviting, or was it plastered with financial notices? Was the receptionist rude or friendly? How long was the patient left waiting before he/she were seen? All of these issues have the potential to leave patients feeling uncared for and can reduce a patient’s adherence to treatment. So context can determine perception. Setting the right context—having a clean, organized accessible office, staff who are friendly and attentive, office signs that speak about trust and caring, and a schedule where patients are seen on time—will help assure that patients perceive that their doctor cares about them.

In my October PM360 column, we’ll investigate the physician behaviors that affect patient perceptions that ultimately determine how well patients use their medicines. We’ll also look at how other interested parties— companies, marketers, etc.—can do some of the same things doctors can do to help patients be more adherent.

  • Steven Feldman, M.D.

    Dr. Steven Feldman is Professor of Dermatology and Public Health Sciences at Wake Forest Baptist Medical Center. Steve studies patient adherence at North Carolina’s Wake Forest Baptist Medical Center. He is also Chief Science Officer of Causa Reseach, an adherence solutions company (www.causaresearch.com), founder of www.DrScore.com, and author of “Compartments” and “An Illustrated Dictionary of Behavioral Economics for Healthcare Professionals.”

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