The reasons why patients show non-compliance to treatment are multifactorial and there are no straightforward answers to it.
Simran Rao, a woman in her early twenties has PCOS (polycystic ovarian syndrome). She has been on a year-long treatment that includes birth control pills. Well aware of the fact that the condition can only be managed well, she often weighs the sustainability of these pills.
Simran said: “I sometimes think of finding an alternative treatment that has more sustainability and lesser side effects. Maybe I will try other schools of medicine like homoeopathy. I am not saying that my doctors are overprescribing pills but the upcoming studies on the side effects of contraceptives are making me and many of my friends a bit worried about continuing them for the long term. Doctors sometimes don’t provide us with the answer to ‘How long?”
Kumar Karun, a man in his late twenties, based in Bengaluru believes firmly in the rationale behind his doctor’s prescription.
Sahil Choudhary, a man in his mid-twenties, who works as a coder in an IT firm seconded Karun’s thoughts on completing the course of treatment as prescribed by the attending doctor. However, he said that just like in any other field, medicine is not also free from corruption.
He said: “I believe in my physician’s advice but I can’t say that for all doctors in the country. Just like some patients carelessly pause the treatment, there can be a possibility of some doctors overdoing it for personal gain. Corruption is a ground reality. Even medicine is not free from it. Our country is also dealing with problems like quackery. Getting cut from an attached pharmacy could lure some into overprescribing harmless drugs.”
Patient adherence or compliance to treatment is of utmost importance on the path of recovery. As per WHO, many people die across the globe because they failed to take their treatment properly. As per reports, around 25 per cent of all hospital admissions happen due to patients’ non-adherence to the prescribed treatment.
Non-compliance to treatment is multi-factorial
Reports have shown that a good percentage of people having kidney transplants fail to take their anti-rejection treatment. The same also goes for conditions like hypertension which if not managed well can lead to negative cardiovascular outcomes. However, the reasons why patients show non-compliance to treatment are multifactorial and there are no straightforward answers to it.
Richa Massey, a teacher in her forties said that whenever she is in treatment, she makes sure to check the composition of the drugs prescribed.
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She said: “I don’t check the contents of the drugs to scale my doctor’s expertise. I do it to upgrade myself on the disease and understand which medicine does what in our body. A person who doesn’t understand the role of antacids or multivitamins in our body would likely perceive them to be as unnecessary. Lack of understanding about their disease and the medicines that need to be administered can become the cause of patients turning doubtful of the treatment.”
Socioeconomic barriers like poverty can make patients skip appointments and pause treatment halfway through. Other factors that could lead to treatment non-compliance are individual traits, lack of insurance support and the kind of diagnosis.
Two minutes for each patient? Doctor explains
A study published by the British Medical Journal in 2017 revealed the average time doctors spend on patients in India was not more than two minutes. If the figures are true, the short duration of interaction between doctors and patients could be faintly related to the problem of over-medication if it might take more than one visit for the doctor to diagnose the condition.
To understand the situation more objectively, the Health site spoke to Dr Shiv Kumar who works as a physician at ESIC Hospital (Bengaluru).
He explained: “Spending adequate time talking to the patient is the best way to have the best outcome for all parties. But unfortunately, we don’t have enough time to enquire about all aspects of a patient’s life in OPD with the lines only getting longer in hospitals. For instance, understanding that a patient has a strict vegetarian diet and it aligns with his religious views and understanding he or she has to eat a strictly vegetarian diet coz of family practices is information at different levels which is achieved only if you ask and speak enough to the patient.”
Talking about an ideal consultation, Dr Kumar said: “Overprescribing is a very common practice, especially for geriatric age groups and patients of post-menopausal age looking for symptomatic relief. An ideal consultation should enquire about the patient’s questions and concerns and have enough time spent on understanding his family environment, work environment and individual ideas about disease and treatment. Patients should also be given a golden minute to put forward all their problems without interruption in between. An average doctor interrupts maybe 15-20 seconds into a conversation. Just understanding the presence of symptoms will never cure a patient right.”
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