These days, health care systems are trying to cut costs by preventing unnecessary health care utilization. Conversations about this issue sometimes revolve around “non-compliant” patients, people who don’t follow medical advice or use the emergency room for non-emergencies. In this piece, a patient describes how she became a “non-compliant” patient and offers some suggestions for what health care providers can do to improve the patient experience.
I don’t know when I became a “non-compliant” patient.
Maybe it started in childhood. There was that stubborn fever the pediatrician kept dismissing as a cold when I was six years old. It ultimately landed me in the ER one night. I was initially diagnosed with appendicitis, but it turned out to be pneumonia so severe that the ER doctor told my parents they would have been making burial plans in the morning had they not brought me in that night.
Maybe it started in adulthood. There was the incorrectly inserted IUD that caused constant bleeding and pain so it eventually had to be removed.
Was it the time the urgent care clinician refused to write me a prescription for antibiotics? I had taken my niece swimming at a city beach. The two of us — along with many other revelers, I learned later — awoke very ill the next morning. According to news reports, the bacteria in the water was three times an acceptable level. But at urgent care I heard, “No one gets sick from swimming.” I ended up asking a relative if they had any unfinished antibiotics, and felt better after taking them for about five days.
I blew off regular appointments, which often resulted in me going to the ER for issues that could (or should) have been addressed at a clinic visit. Doctors chastised me for not taking a prescription they wrote for me. I didn't fill it because I'd seen people suffering side effects from the medication, and eventually found an herbalist to help me.
This sequence of adverse experiences eventually dulled my senses. I stopped listening to doctors because I didn’t believe they were listening to me.
I’ve tried to see things from health care providers’ point of view. They seem overworked. Maybe my provider was answering emails at midnight (again) last night, so she was exhausted for her 7:00 AM start this morning. Then I show up 15 minutes late for my appointment, and put her even further behind schedule.
I know physicians probably feel they don’t have enough time with patients. Maybe their days are filled with paperwork, writing or dictating notes, checking lab results, making phone calls, lengthy (too often useless) meetings, and missing lunch or eating at their desks, if they’re lucky.
I can’t imagine this is how providers pictured their careers when they went into health care.
Meanwhile, I sit in the waiting room, and worry about what I’ll be chided for this time. My providers don’t know the first thing about my life, my responsibilities, my stresses, but they tell me what to do and how to do it with almost absolute certainty that what they say is the best thing for me and my world. In the midst of yet another degrading encounter, I ask myself, why am I here?
Let’s be honest: this dynamic is terrible for my providers and for me. I know clinician burnout is real, but so is patient burnout. I understand that providers may be tired of feeling as if people stand over them with calculators and stopwatches while they try to care for patients. No professional wants to be treated as if they’re a factory worker. No patient wants to be treated as if they’re the product going by on the conveyer belt.
Here’s my advice to providers who are trying to reduce costs and improve outcomes.
The next time I don’t follow your instructions, please take a few minutes to find out why. Instead of jumping to conclusions, admit that you probably know little about me. Humbly inquire about what might be getting in the way.
Instead of just telling me what I need to do, ask me, “What matters to you?” Respectfully discussing my answer may help us both understand what would motivate me to modify my eating habits, take a medication, regularly exercise, or otherwise make big changes in my life.
To me, health care is the combination of medical innovation and clinical application via a trusting relationship for the betterment of the patient. In other words, a strong relationship between a clinician and patient is essential for health care to be most effective.
When providers forget that, it reduces them to nothing more than a mechanic, seeing me as a collection of parts to fix. And I'm not. I’m a person. Just like my doctors.
Allison Luke is an IHI Executive Assistant.
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