October 13, 2014
Doctors Whine about Non-compliant Patients
The way doctors whine about non-compliant patients is sickening! Every time they point a finger at a patient, they should remember there are probably three fingers pointing back at them. Yes, I said this and hopefully I can provide some insight. Admittedly, there are some patients that no doctor can help, but many more are just plain tired to their doctor's attitude. Because this Medscape article used the example of A1cs, I will use patients with type 2 diabetes.
Some reasons that good patients are non-compliant:
#1. The doctor is too paternalistic. These doctors have all the answers and will tell you they do not have time for education, no time for talking with the patient, and no time to instruct patients. For these doctors, it is a revolving door and they make more money this way. They will deny missed diagnoses and unhappy patients, but they insist that they have overhead to cover. Do some observations and you will notice too many employees sitting and gossiping, doing nothing and in general, not working. Efficient offices are the exception to this and they are few and far between.
#2. Too often referrals are made to dietitians that promote food plans of whole grains, high carbohydrates, and low fat. Most people with type 2 diabetes on oral medications cannot tolerate these food plans. Even patients with type 2 diabetes on insulin cannot or should not tolerate these food plans. Plus, many are not prescribed a high enough dose of the medication or combination of medications to handle the high level of carbohydrates. Then it is small wonder that the A1c levels show non-compliance. Patients then become discouraged and the A1cs tend to climb.
#3. The doctor does not compliment or encourage small successes. Too often the doctor is the one setting the goals and these are often unattainable because they are too high and could take most patients six to 12 months. If they were reasonable three month goals and reasonably attainable, then if the patient has input into setting the goals and is complimented when they achieve the goals, they are more likely to work harder for the next goal. Positive reinforcement is generally not forthcoming from many doctors.
#4. Very few doctors provide informative websites for reliable information. This is their shame and could be very informative and helpful to many patients. Yes, this would require some effort, but often the people working for them could gather much of the information for them to review and put together lists of URLs for each disease or illness. However, the cheapskates won't do this because it will not bring in money. What they may be missing out on is patient satisfaction which may influence the monies they receive in the future.
#5. Many doctors are beginning not to serve non-compliant patients. Yes, some doctors are so worried about losing money that they are refusing to be a doctor to patients they deem as non-compliant. They are only interested in passive patients that will follow their orders and not patients that are proactive and desire to have an input into their treatment. Am I being too harsh? I don't think so, as I am seeing this with many people that I am talking with that are receiving notices from their now former doctors asking them not to come back.
There are a few doctors that are realizing that the landscape is changing and are changing the way they are working with patients. One doctor recently started carefully diagnosing patients at risk for diabetes and is catching more patients with prediabetes and working with them to help them delay or possibly avoid the progression to type 2 diabetes. He is researching and working to help his patients. He is encouraging them to make lifestyle changes and has hired a nutritionist to assist his office and two other offices to help with food changes.
How do I know, because the support groups in our town are all feeling the pressures as he is encouraging his pre- and diabetes patients to join a support group. Even a couple of other supports groups are getting requests in towns around us. We are surprised because all the doctors are cooperating and even encouraging us to make room for his patients. The other doctors have also asked him to start a support group for prediabetes patients. More on this as we become aware of events.