Better Health: Smart Health Commentary Better Health (TM): smart health commentary

Article Comments

Confusing Compliance With Engagement In Our Health Care

Twenty percent of people who leave their doctors’ offices with a new prescription don’t fill it. Up to one-half of those who do fill their prescriptions don’t take the drugs as recommended. These individuals are considered non-compliant. But does that mean they are not engaged in their health care? Engagement and compliance are not synonyms.

I am compliant if I do what my doctor tells me to do.

I am engaged, on the other hand, when I actively participate in the process of solving my health problems. This new prescription is an element in that process. If I am engaged in my care, I might want to learn about this medication. Such as:  what it can and cannot do to ease my pain or slow the progress of my disease; what side effects it might produce and what I should do about them; how long it will take to work; when I should take it and how; how much it may cost; and what will happen if I don’t take it. I might want to consider the barriers to taking it and weigh the risks and benefits of alternatives. Could I instead make changes in my physical activity level or diet, try a dietary supplement or watchfully wait to see if the symptoms subside?

If my clinician has done more than just hand me the prescription – if she has, for example, raised these questions and discussed these concerns with me, I probably won’t have a prescription in my hand if I don’t intend to fill it.

But I can be engaged in my health care even if I don’t have that conversation with my provider. I can ponder each of these questions with family and friends. I can search the library and Google for answers. I can consult online with others who have taken that medication. And sure, I’ll accept the prescription in case I decide to fill it. But I make no guarantee.

The rhetoric of engagement is attractive to all of us: patients, providers, hospitals, employers and health plans. That rhetoric says that we have “choices” about our health care, that we are “empowered” to participate actively in our health care. And of course, that it’s time we “take responsibility” for our health.

Many who speak about the need for us to engage in our health care confuse compliance with engagement. They assume that the only rational choice we can make is to behave consistently with our clinicians’ directives, whether that means filling a prescription, losing weight or undergoing surgery.

But this is not how many of us hear these messages. The rhetoric says we have choices? We hear “You have the power to choose which doctor to consult and which advice you will follow.” It says we are empowered to find good health solutions? We hear “Your Web searches and new friends online can help you figure out what to do as well as your doctor can.” The rhetoric says we are responsible for our health and health care? We hear “You are on your own.” What we hear is reinforced by reality: a paucity of clinicians who encourage and welcome our participation in our care and office visits that rarely allow time for in-depth conversations.

Saying “engagement” when meaning “compliance” supports the belief that we are the only ones who must change our behavior. Doing so misrepresents the magnitude of shifts in attitude, expectations and effort that are required for all health care stakeholders to ensure that we have adequate knowledge and support to make well-informed decisions. And it fails to recognize that our behaviors are powerfully shaped by many contingencies – money, culture, time, illness status, and personal preference.  Being engaged in our health and care does not mean following our clinicians’ instructions to the letter.  Rather, it means being able to accurately weigh the benefits and risks of a new medication, of stopping smoking or getting a PSA test in the context of the many other demands and opportunities that influence our pursuit of lives that are free of suffering for ourselves and those we love.

*This blog post was originally published at Prepared Patient Forum: What It Takes Blog*

You may also like these posts

    None Found

Read comments »

Comments are closed.

Return to article »

Latest Interviews

IDEA Labs: Medical Students Take The Lead In Healthcare Innovation

It’s no secret that doctors are disappointed with the way that the U.S. healthcare system is evolving. Most feel helpless about improving their work conditions or solving technical problems in patient care. Fortunately one young medical student was undeterred by the mountain of disappointment carried by his senior clinician mentors…

Read more »

How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

Read more »

See all interviews »

Latest Cartoon

See all cartoons »

Latest Book Reviews

Book Review: Is Empathy Learned By Faking It Till It’s Real?

I m often asked to do book reviews on my blog and I rarely agree to them. This is because it takes me a long time to read a book and then if I don t enjoy it I figure the author would rather me remain silent than publish my…

Read more »

The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

Read more »

Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

Read more »

See all book reviews »

Commented - Most Popular Articles