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If Consumer Reports Says So, and the Wall St. Journal Reports On It, It Must Be True

By Dr. Paul Ehrlich
As reported in the Wall St. Journal, a Consumer Reports survey of 660 primary-care physicians gives the number one complaint doctors have about their patients:
Noncompliance with advice or treatment recommendations. Some 37% said it affected their ability to deliver the best care by “a lot.”
Our millions of readers (I wish) are aware that we harp about this all the time. So do those who have read Asthma Allergies Children: a parent’s guide (there aren’t nearly enough of those either)—we even have a section called “Compliance, Compliance, Compliance.” To their credit, the Consumer Reports article takes a nuanced view of compliance:
“[C]ompliance these days can be a lot more complicated than just remembering to take a pill,” citing patient advocate Jessie Gruman, Ph.D., president of the Center for Advancing Health, a patient-advocacy group in Washington, D.C. “Hospitals are sending patients home with long lists of self-care chores. Drug and lifestyle regimens allow those with chronic conditions to live longer, healthier lives but can be difficult to manage or, in some cases, for patients to afford.”
The article goes on, “’Compliance doesn’t necessarily mean following your doctor’s instructions slavishly,’ said Ronald Epstein, M.D., director of the Center for Communication and Disparities Research at the University of Rochester Medical Center in New York. Some patients don’t follow treatment programs because they’re disorganized, he said, but others might fail to comply because they’ve experienced serious side effects, don’t fully understand what they’re supposed to do, or found the treatment wasn’t working. ‘Doctors need to make it safe for patients to bring those things up,’ he said.”
Consumer Reports also recommends that patients feel free to discuss, even debate, a doctor’s treatment plan while still in the office. “Then do your best to comply. If you’re having side effects, are unsure whether you’re following instructions properly, or experience new or recurrent symptoms, tell your doctor immediately.”
I welcome this kind of give and take, but as well over 30 years of practice have taught me, compliance in the real world depends on lots of give and take, and, in the case of doctors, it may take a lot of give, give, give before the process of give and take can begin.

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