Health Biz India January 2014 52

Information Therapy

By: Dr. Aniruddha Malpani

I was invited to give a talk recently on improving patient compliance. The

healthcare brand wanted to learn more about what they can do to improve the number of patients who sign up for the surgery which they so obviously need.Poor patient compliance is a big issue today. When a doctor

gives patients instructions (do these tests and take these medicines), the doctor expects blind obedience from the patient. After all, the doctor is the medical authority, and if the patient has come to him for his advice and is paying for it, isn’t it logical to conclude that he will follow the advice given?Well, time for a reality check. The fact is, patient compliance can be as less as 50 per cent

(or even more), especially for patients with chronic illnesses. A lot of patients will not take the medicines which the doctor prescribes – and this is very frustrating for doctors. This is why most doctors think of their non-compliant patients as being one of the three monkeys of Gandhiji. They start believing that patients who do not follow their orders are:• dumb,becausetheydonot

understand what’s good for them; or

• blind,becausetheydonotsee the consequences of not listening to the doctor’s orders; or

• deaf,becausetheydon’tseem to listen to anything which the doctor tells them, no matter how much time he’s spent educating and counseling them.Doctors will often get fed up

and say – if the patient does not want to listen and wants to reduce their life span by ignoring what I tell them, then that’s their problem – I have done my best.

Ironically, patients also believe that their doctors resemble these three monkeys!

They usually believe that doctors are:• deaf,becausetheyrefuseto

listen to them;• blind,becausetheydo

not seem to care about or

Doctors, Patients & Gandhiji’s 3 MonkeysDoctors and patients, both seem to (tragically) think that the other one is a Gandhiji’s monkey, either dumb or blind or deaf!

Health Biz India January 2014 53

Information Therapy

ww

w.h

ealth

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.inunderstand their feelings or preferences; and

• dumb,becausetheydonotbother to explain or share information; and do not understand that they are speaking in a completely foreign tongue which the patients cannot comprehend!Both these worldviews are

valid, which is what makes it more tragic; as poor patient compliance is bad for both patients and doctors.

This is why it’s important for doctors to engage with their patients and not treat them as monkeys who are going to blindly obey everything they tell them. Some doctors still treat patients as puppets, who will do everything they are told to do. This is not true, and patients need to be treated with respect and empathy. Good doctors are able to do this efficiently, so that their patient compliance rates are far better than those of other doctors.

Tracking complianceSadly, compliance is not something which most doctors track. Most are blissfully unaware of what a big problem this is. Every doctor believes he is exceptional – and most bad doctors are blind about their own defects. They happily continue to delude themselves that their patients will do to everything they tell them to!

This is why it’s so important to develop tools which track whether patients are following their doctor’s advice. This is where technology has such a big role to play. Technology can allow us to monitor patient compliance – for example, by reminding patients to take their pills on time; and digitally recording when they

have done so.Expert patients can also help

to improve patient compliance. They can share the strategies which they use personally to motivate themselves, so that they are able to comply with their doctor’s instructions. Because they speak a language which patients understand, patients are likely to be far more compliant when told how to do what the doctor tells them to do by expert patients. Smart doctors tap into the expertise of their expert patients in order to improve compliance levels amongst their patients.

Tailor your style For complete patient compliance, the doctors too have to work on themselves. It is high time doctors improve their age-old style of working.

Lots of doctors don’t like entertaining questions from their patients and prefer that their patients just passively follow their advice. If patients want to discuss alternatives or options, they get irate.

This approach is like being one of those monkeys (deaf). They feel that when patients do their homework or try to explore options, they just end up confusing themselves. They also believe that this approach suggests that the patient does not trust the doctor – and that this kind of doubting attitude will interfere with healing and result in poor medical outcomes. What is the ultimate vital point here though? Isn’t it to cure the patient? Then why can’t doctors tailor their style a bit to accomplish the same?

Doctors with egosOne reason doctors refuse to adapt their style is that most doctors come with a baggage of egos. It may pinch to hear this (especially coming from a doctor) but somewhere down the line, all doctors will agree that it’s true.

And from where does the ego set in? Well, doctors have a high opinion of themselves. They have usually been toppers in school, who were always complimented and appreciated

Many doctors do prefer an aware

patient, who asks questions and

explores alternatives

Health Biz India January 2014 54

Information Therapy

for being the best. This tends to make them proud of their skills and hence they have a low opinion of laypeople who aren’t as proficient about science and biology.

Also, medical colleges train doctors to be paternalistic; and it is embedded in their minds that they are supposed to take care of their patients and make the right kind of decisions for them, because they are the experts. This can lead to conflict when the patient and doctor don’t see eye to eye. Lots of doctors find it hard to treat their patients as equals, and often end up telling them what to do, as opposed to explaining or discussing their problem with them.

Sometimes it’s the lopsided doctor patient ratio in India which makes it a problem for doctors to spend enough time with the patients. It’s much more effective for them to just tell patients what to do, leaving no time-window for discussion open, so they can minimise the time they spend with each patient, and improve their throughput, allowing them to attend more efficiently to their

crowd of waiting patients. This leaves many patients unsatisfied, as the doctor makes the decision without enlightening patients about alternate options.

An alternate approachBeing egoistic or resembling a monkey are not the only two options. Doctors can follow an alternate approach. In fact, there are doctors who discuss all possible options with their patients and also let them make a choice about the treatment procedure. These doctors allow patients to choose what they feel is their best option, rather than try to decide for the patient. They feel it’s the patient’s prerogative

to make decisions, and since they cannot read the patient’s mind, they are happy to let him decide for himself. They see their role as a facilitator or coach. They don’t like patients who just want the doctor to tell them what to do. Instead, they prefer an aware patient, who asks questions and explores alternatives.

The latter approach seems to be more sensible as the doctor treats the patient as an adult and a responsible partner. However, there are some patients who don’t like these kinds of doctors and often complain that such doctors aren’t able to make up their own mind! These types of patients prefer authoritative doctors who tell them what to do, as opposed to giving them options and choices. They don’t like to weigh the pros and the cons of their condition as they feel their opinions could create more confusion. They get paralysed when asked to analyse.

Such patients prefer to consult senior doctors who tell them what to do, akin to a father figure. They don’t want to use their own mind and want to trust experts and professionals to make critical decisions for them. Personally, I don’t believe one type of doctor is better than the other. According to me, a good doctor should tailor his approach according to the patient’s needs.

If a patient expects an authoritative figure, then giving him options will not satisfy his needs. On the other hand, patients who are wise and want to discuss their options, should be offered that opportunity. Doctors need to learn to be flexible.

A good doctor should tailor his

approach according to the patient’s

needs