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How to convince the patient to follow the doctor’s orders?

Medical reform is in full swing in Ukraine. Clinics purchase computer equipment, install MIS, doctors master the work with professional applications and teach patients to communicate in instant messengers. But often all progress in the development of healthcare crosses out the banal human factor – patients refuse to comply with doctor’s prescriptions. They either go for a consultation with a couple more specialists, or, having read information on the Internet, they tritely self-medicate.

According to various studies, the reasons for the patient’s lack of adherence to treatment can be completely different. They may be socio-demographic factors, medications, characteristics of the disease, or characteristics of the patient’s personality. However, a number of studies confirm that in most cases the problem lies in the lack of effective doctor-patient communication, as well as a clear obligation for doctors to adhere to .

Doctor Booster also decided to contribute to the study of this problem and asked doctors directly: what prevents patients from following their recommendations, and what are the ways to solve this issue in Ukraine?

Doctors’ comments:
Unfortunately, we have not developed a strategy of complete trust in our doctor. Because there are no adequate European standards of treatment in Ukraine. If, for example, a person goes from one doctor to a second or third, then it is possible that as a result he will receive three diametrically opposed prescriptions for treatment. And here the person finds himself at a crossroads… Well, if all three doctors prescribed the same treatment, then the problem of trust would be removed. This is the first.

The second thing that “interferes” with the implementation of the doctor’s recommendations is that each patient has a certain request for the doctor as a person. For example, someone does not like the way the doctor looked at him, how he smiled. Someone – that this doctor prescribes only droppers, and this one – injections. At the same time, the doctor himself cannot determine what the patient likes more, an injection or a pill right away. And this just creates confidence in the doctor. And this is exactly what primary health care providers – paediatricians, internists and family doctors – need to keep in mind. After all, choosing them, the patient chooses a doctor who will be a good pilot in the world of medicine for his entire family.

If the patient has not yet found a specialist who suits him, he will go to different doctors until he chooses one. And only after that, he will stop watching forums, listening to the recommendations of grandmothers from the bench, girlfriends in chat, etc. With any problem, he will already call his family doctor.

Sergey Gorishchak
Chief Physician of the Children’s City Polyclinic No. 6, Odessa
I see several ways to deal with a situation where a patient does not follow the doctor’s recommendations. For example, if a patient has health insurance, insurance companies, if they do not follow the doctor’s recommendations, can shift the cost of treatment to the patient. That is, if you did not follow the recommendations, pay yourself.

But what if there is no such insurance? Firstly, it is possible to ban advertising of medicines and dispense medicines by prescription, the pharmacist is not entitled to recommend medicines. Secondly, it is necessary to standardize approaches to the treatment of certain nosologies throughout Ukraine. Thirdly, the connection of family doctors with narrow specialists should be chosen (some Internet resource is better). In addition, it is necessary to allocate funds for the training and advanced training of doctors, as well as stop vilifying the profession of a doctor and let patients understand that appointments are not necessary for doctors, but, first of all, for them.

Andrey Semivolos
Chief Physician of the Kiev City Children’s Diagnostic Center
The question, in fact, is very complex and multi-level. The unwillingness of patients to follow the recommendations of doctors, firstly, demonstrates the attitude towards the doctor, which is a reflection of the general state of professionalism of the doctors themselves. In our healthcare system, when you go to, say, four doctors, you can get four different opinions, which are based on the “own experience” of each of the doctors. In such turmoil, the patient is often looking for those recommendations that coincide with his worldview.

Secondly, with us, the patient can be treated himself, given full access to the purchase of medications and the lack of a medical culture. People believe that an antibiotic will speed up recovery from everything and, conversely, a drug that the patient “does not understand” can be ignored.

Thirdly, doctors often consider it above their dignity to explain to the patient the features of his condition and why treatment is necessary.

Fourthly, our doctors are not accustomed to sharing responsibility with the patient. This is what is called shared decision making in English. But, for this, you must first explain, and then accept that the patient or parent is responsible for health on a par with the doctor.