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Dr. Joseph Sirven: Somebody's Watching Me
My patient starts with, “You need to edit your last note about me. ‘I am not compliant?' Who do you think you are? No one tells me what to do!”
I gently explain that she had told me that she forgets to take some of the medications I’ve prescribed and I wanted to basically indicate that in the chart.
She responds, “I listen to your advice and it’s up to me to decide whether to follow it or not.”
My patient made an important point. It used to be that patients who did not follow doctor’s directions were described as not being "non-compliant." That term is now a pejorative term and people don’t like it, as my patient exhibited. The words "adherent" and "non-adherent" have now replaced it. This issue of following medical advice and the words used to describe it has gotten a lot of attention.
According to recent data from the World Health Organization, non-adherence is defined as not following directions or filling prescriptions — and they account for 50 percent of treatment failures, 125,000 deaths and 25 percent of hospitalizations each year in the United States.
Typically, an adherence rate of 80 percent or more is needed for a medication to show an effect. In the US, the average adherence to a prescription is 50 percent. The reasons for this are numerous including rising drug costs, remembering doses, and side effects.
Technology is now ready to help. From electronic alarms apps on your phone, to special pill bottles that literally alert you to take your medications. We are awash with gadgets ready to serve as health assistants.
Have you heard of the digital pill capsule that communicates with an app on your phone so that it sends a signal to you or your doctor when the medication has been digested? The first drug approved by the FDA in this digital pill is a combination of psychiatric medications used in the treatment of schizophrenia.
Although there are lots of justifications why we as patients may not follow medication instructions, sometimes the easiest first step is simply to let your doctor know you’re having trouble taking the medication so you both can work on a solution.
As far as prescribing that special digital adherence pill let me paraphrase Rockwell’s 1984 hit song “Somebody’s Watchin’ Me:” I always feel like somebody’s watching me and I have no privacy.
Who knew that a pop song could be so prophetic?