How Do You Ensure Patient Compliance?

This transcript has been edited for clarity.

Hello and welcome. I'm Dr George Lundberg and this is At Large at Medscape.

How do you ensure patient compliance? This is a question for advanced clinicians. Full disclosure: I am not one. The last time I practiced strictly clinical medicine was in 1957-58 as a rotating clinical intern (in Honolulu yet).

Since then, I have spent my professional life as an anatomic, clinical, and forensic pathologist, and, since 1982, as a general medical editor and journalist.

In both roles, it has been my job to stay on top of big-picture medicine, trying not to miss anything really important to the broad field, including public health and health policy, all the way to biostatistics, epidemiology, and molecular pathways of disease and potential interventions.

For the fine details of clinical medicine, I must rely on honest, open-minded, intelligent, well-educated, observant, and experiential clinicians, be they MDs, DMDs, DDSs, DVMs, NPs, PAs, RNs, PharmDs, RDs, DPMs, PTs, PsyDs, DCNs, even DCs. (Did I miss anyone?)

So, you, dear experienced clinician-reader, teach me (and other readers).

I believe in the ability of the human body to heal itself of most maladies, most of the time. But sometimes the intervention of a skilled clinician can make a real difference, either for better or worse; to effect a cure, or at least improve disease management, daily function, and symptom control.

So, if you are reasonably certain that a specific intervention has a good chance to be beneficial, and that intervention includes actions that the patient or family must take, how do you make sure that happens? How do you ensure patient compliance in vital, even life-saving, circumstances?

Remember: Assuming that you have the science right, the purpose of patient compliance is to improve outcomes.

For example:

  1. Actions that prevent young people from becoming nicotine addicts

  2. Tobacco-use cessation

  3. Alcohol-use disorder follow-up after intervention

  4. Body weight optimization

  5. Hypertension control

  6. Full-series antibiotic use

  7. Tamoxifen to prevent breast cancer

  8. Asthma control

Help me understand the best ways to accomplish these goals. Most actions that affect human health and disease occur outside a hospital, a clinic, or clinician's office. People do, in fact, take charge of their health or their disease—promotion, prevention, perpetuation, or enhancement.

How do you, as a designated, responsible clinician, assure that such actions (or lack thereof) are beneficial? If you cannot, at some reasonable/realistic level, why would you pretend you can, coming to work and taking payment, if, outside your line of sight, the necessary actions are not taken?

This is all about human behavior and how to influence patients' behavior to improve their health. It is the patient's and the public health outcomes that matter most, not only the involved processes.

So, back to the top: How do you (at least try to) ensure compliance?

Please share your most successful methods and techniques. I am eager to learn.

That's my opinion. I'm Dr George Lundberg, at large At Medscape.

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