Should Doctors Be Penalized for Patient Outcomes?

Leigh Page

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November 03, 2016

In This Article

Adherence Techniques Can Be Simple

Effective adherence techniques don't have to be as complex as many experts are recommending, says Steven R. Feldman, MD, a dermatologist in Winston-Salem, North Carolina. Although he doesn't believe adherence can ever reach 100%, he says that he has enhanced his own adherence rates by taking the following steps:

Make adherence your responsibility. "Your basic assumption should be that patients won't follow the treatment unless you make the effort to get them to do so," he says.

Build patients' trust. This is done in many little ways, such as having plenty of parking, a clean waiting room, and a polite staff, and by personally dealing with patients in a respectful, unhurried manner.

Select treatments that patients will actually use. For example, "greasy ointments may be the preferred treatment, but if patients don't like them, you're going to need to give them something else," he says. For many conditions, there are usually other treatments that are basically just as good.

Prepare patients for side effects. If a medicine is going to sting, "I tell patients that's a sign that it's working," Dr Feldman says. "So when they feel the sting, they see it as a positive experience—'It's working.'"

Ask patients to check back in 3 days. If patients are asked to contact the doctor very soon after they get the prescription, they are motivated to immediately start using it, he says. And once they use it, they'll start seeing positive results and that will motivate them to continue use. When several weeks have elapsed, patients will be less likely to start the medication, he says.

Dr Feldman insists that his techniques don't take any extra time, even during the office visit. If they did take extra time, he believes most doctors wouldn't want to use them, because they simply don't have the time to add even a minute or two to the office visit.

He thinks paying attention to adherence is an essential physician skill, comparable to diagnosis and selecting a treatment plan. "If you make the right diagnosis and select an effective treatment plan, it doesn't mean anything if the patient doesn't follow it," he says.

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