Sanjiva Wijesinha -writer and physician

Short stories, Travel and Health Information

How to Comply with your Doctor’s Advice

General Practitioner

General Practitioner

I had a pleasant experience recently meeting some old friends from my medical school days.

Though many years have gone by since we graduated, we were able to reminisce about those days last century when we took our first hesitant steps into the world of medicine — and marvel at how much has changed in the field since then.

Although medical technology has advanced tremendously and methods of diagnosis as well as therapy have changed (in some instances, quite drastically) we realised that not much has really changed when it comes to getting patients to comply with the advice we give them.

When a patient comes to us, it is usually not difficult to diagnose what is wrong and decide on the appropriate treatment. Even as a GP working in a small clinic, you don’t need CT scanners and expensive blood tests to make these decisions. What is difficult, however, is convincing the patient to follow our advice. As one of my friends observed: “Horses will come to the water trough and even pay you a handsome fee for the privilege — but that does not mean they will drink the water you offer them.”

This brought us onto the topic of whose responsibility it was to ensure that a patient complied with the medical advice that a competent, well-trained and well-intentioned medical practitioner gives him or her. Can, or should, a doctor spend time and effort trying to care for a patient who doesn’t care about themself?

As a classic example, I have a patient who does not smoke, drinks minimal alcohol, exercises reasonably regularly and is not overweight. Unfortunately, he has very high blood pressure and a strong family history of heart disease. But he does not, under any circumstances, want to take tablets for the rest of his life.

I have measured his blood pressure on several occasions in my consulting room, showed him the sphygmomanometer reading (never less than 190/100) and tried to convince him that he has a very high risk of suffering a premature heart attack just as his father and his older brother did, unless he accepts that he needs to take tablets on a regular and long-term basis.

He responds every time with: “But I feel fine, doctor — I don’t feel unwell at all! I don’t want to start taking any tablets.”

When I was younger, I would look on my inability to convince him as a failure on my part. But as I have got older, I have come to accept that in situations like this, my agenda as a good doctor comes into conflict with what matters to the patient: to feel that he is not an invalid who needs to take tablets.

Unless he is convinced that taking tablets to lower his blood pressure will be beneficial to him, unless he buys into what I have been trying so hard to tell him, unless he accepts my advice and makes it his own, he will not comply with my advice — and will continue to be at serious risk of succumbing to his family tradition of a premature but preventable heart attack.

Perhaps we should have been taught not only medicine and doctoring in medical school — but also the art of spin doctoring.

Information

This entry was posted on August 24, 2013 by in Uncategorized and tagged , , , .
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