The number one goal of every physician and advanced practice provider is to help their patients have better medical outcomes. However, patients themselves can unintentionally thwart your best efforts. The cost of non-adherence is immense, not only in terms of the toll on patient health and well-being (up to 275,000 U.S. deaths a year) but financially as well. In the U.S. alone, non-adherence’s yearly cost is nearly a half-trillion dollars due to medical complications, follow-up trips to physicians, ER visits, ancillary care like PT, and hospitalization. The good news is that providers can take preemptive action. Here are five tips that will help you increase adherence to patient instructions.
1. Write it out
Human nature works against patients remembering a provider’s instructions. According to Learning Solutions Magazine, people generally have lousy memories.
“How much do people forget? Research on the forgetting curve shows that within one hour, people will have forgotten an average of 50 percent of the information you presented. Within 24 hours, they have forgotten an average of 70 percent of new information, and within a week, forgetting claims an average of 90 percent of it.”
After telling a patient the condition he or she is facing and the treatment they are to follow, providers are wise to write out the details. Or better yet, encourage the patient or even a family member to write down the instructions or details just covered. Having a pen and pad of paper handy, of course, will facilitate the process. The more times someone interacts with information — by hearing, writing, or reading what they’ve written and repeating out loud what they’ve heard — the more likely they are to remember it.
2. Elicit meaningful feedback
Most people, physicians and APPs included, take head nods as an indication they’re being understood. Or they go one step further after explaining something and ask, “Any questions?” When the patient answers, “No, no questions,” it’s natural to assume you communicated effectively, and you and the patient are on the same page. In reality, most people nod or answer “do you understand” questions reflexively, not wanting to appear ignorant or thinking they’ll be wasting your time asking for clarification.
Mutual understanding is better served when you say something like, “These instructions can be confusing. Why don’t you say them back to me in your own words?” That way you can determine for sure how well you were understood. Repeating instructions helps solidify them in a patient’s mind, allowing for better recall at a later date.
3. Listen effectively
Listening effectively means listening physically, that is, with ears and eyes. When the patient sends a conflicting message, like verbally saying, “yes, I understand,” but their voice and posture says they don’t really, the non-verbal signals convey over 90 percent of the patient’s true meaning. Watch for and question non-verbal cues you detect.
For example, if you say, “I noticed you winced a little when I mention the meds I’d like you to take. Can I ask you why?” — you might find that the patient is afraid of the medication’s potential cost and will be unlikely to fill it. Almost a third of all prescriptions are never filled, and 50 percent aren’t used as prescribed. Uncovering that hesitation may allow you to prescribe a less costly alternative or generic version.
Perhaps the patient fears the drug’s side effects. In this case, you can discuss them with the patient, put them in perspective, and diminish the patient’s worries. Such clarification will go a long way toward increasing adherence to your instructions.
4. Be attentive to how you listen
As we saw, inflection and body language carry significantly more of any interpersonal communication than words alone. That holds true for you as the healthcare provider as well.
For instance, making eye contact with a patient; speaking with the patient at eye-level; putting away distractions; leaning toward the patient; smiling frequently; speaking with a sympathetic tone; using simple words the patient can understand: these all enable that all-important provider-patient connection.
Every patient visit should end with the doctor or APP summarizing not only what he or she said, but also how the patient’s concerns or questions were addressed. This may feel redundant and repetitious, but repetition fosters retention. The patient will appreciate that more than you may ever know.
Implementing these five steps will help increase adherence to patient instructions and can result in better outcomes — exactly what both you and your patients are looking for.
What do you do to help make sure your instructions are heard and understood? Share your tips in the comments below.