Enhancing Patients’ Treatment Adherence
This month, I just want to share a few pearls from the adherence research lab, (AKA my clinic). This brief checklist of items is designed to communicate to patients that I care about them, which is the foundation of getting them to use their medication.
1. Open the door slowly
I am in a hurry in my busy clinic. There are a lot of patients who want to see me, and I don’t want to disappoint them, so I schedule a lot of patients. I run from room to room as not to keep them waiting, but I do not want patients to get the impression that I am in a hurry. I want them to feel like I have time for them, so when I get to the door of their room, I open the door very slowly. It probably doesn’t take 2 seconds to open the door slowly, but the difference between opening a door in 2 seconds versus 0.5 seconds can leave a big difference in patients’ minds about whether I’m in a hurry. If they think I’m in a hurry, they may think I don’t care about them; if they think I don’t care about them, they may not use the medication I prescribe as well, either.
2. Say something memorable about the hand sanitizer
After I walk into the room, I take some hand sanitizer from the dispenser on the wall in full view of the patient. I could take the hand sanitizer from the dispenser on the wall just outside the room, but if I did that, patients wouldn’t see me using the hand sanitizer. We have to use the hand sanitizer to assure we don’t spread germs from one patient to the next, and we should use the hand sanitizer in front of our patients so we can assure that they know we care enough about them not to spread germs.
While using the hand sanitizer, I like to make a brief, colorful remark about using it in order to make the fact that I used the hand sanitizer unforgettable. A comment like, “This is to protect you from Ebola virus and flesh eating bacteria and whatever else goes around doctors’ offices,” usually elicits a little chuckle from patients. I want patients to remember that I used the hand sanitizer. They may be asked about it on patient satisfaction surveys, or they may hear about doctors who don’t wash their hands on National Public Radio in their cars on the way home from my office. My patients will remember that I used the sanitizer; if they don’t, they may be left wondering about the quality of care I offer, lose trust and faith in me, and not take their medications as well.
3. Put your hand on the patient’s shoulder at some point
A personal touch communicates caring. In today’s society, touch has to be done in such a way that it unambiguously communicates caring and is not misinterpreted as an inappropriate gesture. Putting a hand on the shoulder while communicating how medication should be used and what to expect with the medication may help improve how well the medication works by getting patients to use the medication better.
4. Be personable
OK, this is a tough one for me, because I am a natural test tube-oriented research scientist. Some patients may have confidence in and put their trust in the hands of a test tube-oriented research scientist-type physician, but I have the general impression that pretty much every patient will have confidence in and put their trust in the hands of a Marcus Welby-type physician who exudes a warm, caring, personable demeanor. It is a bit of a show for me to come off that way, but my goal is to get my patients well, and to do that I have to make the correct diagnosis, prescribe the correct treatment, and exhibit the behaviors—even if they don’t come naturally to me— that will help make patients take their medication.
—Dr. Steven Feldman is a professor of dermatology and public health sciences at Wake Forest Baptist Medical Center in Winston-Salem, NC, where he studies patients’ adherence to treatment. He is also Chief Science Officer of Causa Reseach, an adherence solutions company, founder of www.DrScore.com and author of “Compartments”.