We know you’ve dealt with patients who have their own agenda, who do not follow instructions, who are apathetic with their care and treatment, or who are otherwise “difficult.” These patients can be a source of frustration for you and your office staff. They take up more of your time (and your staff’s time) and tend to have poor outcomes – and consequently, also tend to be dissatisfied with your care.
So, what can you do to improve patient compliance and get patients to take an active role in their treatment? By investing some time to develop skills to effectively collaborate with these patients, you will ultimately save time and frustration, and hopefully, improve their health outcomes.
Build Rapport with Your Patients
Building rapport begins when you first meet your patient and continues with each subsequent visit. Show authentic interest in the patient as a human being. This will give you valuable insight into the patient’s world so you can better understand their needs.
Give your patients your full attention and capitalize on non-verbal communication such as smiling, eye contact, and sitting at eye level. Practice active listening by focusing on the patient while they are speaking. Avoid judgment, demonstrate interest, and don’t interrupt. Be sincere and concentrate on what the patient is communicating verbally and nonverbally.
Gather information from the patient about the reason for their visit. What is going on with the patient? How does this affect the patient? What about this bothers the patient most? How is the patient managing the situation?
By building rapport with your patients and treating them with respect and showing empathy, you can improve communication, compliance, and outcomes while resolving conflict, building trust, and avoiding any misunderstandings.
Ensure Patient Understanding
Does the patient understand their condition or the importance of treatment? Ask the patient what they know or think they know and where they got the information. Replace any misinformation with accurate information.
Do not assume the patient knows medical terms. Explain the meaning of a medical term when you first use it. Incorporate diagrams and educational handouts to enhance your education and ask patients to explain to you what you just said. Did they understand? If not, additional instruction is needed. A family member or caregiver can be included in education and instructions to assist in patient understanding.
Identify the Reason for the Patient’s Non-Compliance
Try to determine the reason for the patient’s noncompliance – intentional or unintentional. Are they afraid of treatment? Are they able to afford treatment? Can they be away from work for an extended period? Do they take care of children or aging parents? Are there religious, language, or cultural issues? Is the patient overwhelmed? Does the patient need to make lifestyle changes?
Include patients in the development of a realistic treatment plan that you and the patient can agree upon. Empower the patient by giving them choices. However, you have the ultimate responsibility for the patient’s care. Do not go along with a treatment plan against your better judgment.
Document Everything
Document all conversations with the patient and family/caregivers. This includes patient education and instructions, questions asked by the patient and your answers, and any patient concerns and your response.
Document your rationale for your treatment decisions. There may be several treatment options, but you consider a patient’s history, co-morbidities, lifestyle, and many other factors when recommending a treatment plan for your patient. There is always a risk that the patient will have an adverse outcome or not respond to your chosen treatment. Should a lawsuit develop, a common allegation is the physician ordered or performed inappropriate treatment and did not consider other treatment options. It is much easier to defend if you contemporaneously documented your decision-making process.
Document patient statements of non-compliance and your observations of non-compliance (e.g., a dirty cast bottom when the patient was instructed to be non-weight bearing). Document your discussions with the patient regarding the risks of non-compliance. If a patient suffers a bad outcome because of their own actions or inactions, it is much easier to defend allegations of malpractice against the physician if the patient’s non-compliance is documented in the medical record.
Despite your best efforts, there will be an occasional patient that is just not a good fit for your practice, and by keeping them as a patient, you put yourself and your patient at risk. Consider formally terminating your relationship with the patient. To reduce the risk of allegations of patient abandonment, it is important to follow a formal process for termination of the relationship that is respectful, optimizes continuity of patient care and patient safety, and follows state laws and regulations regarding written notice, emergency care, and referrals.
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The information contained on the PICA Blog does not establish a standard of care, nor does it constitute legal advice. The information is for general informational purposes only. We encourage all blog visitors to consult with their personal attorneys for legal advice, as specific legal requirements may vary from state to state. Links or references to organizations, websites, or other information is for reference use only and do not constitute the rendering of legal, financial, or other professional advice or recommendations. In the event any of the information presented conflicts with the terms and conditions of any policy of insurance offered by ProAssurance Insurance Company of America, the terms and conditions of the actual policy will apply. All information contained on the blog is subject to change.
