If you diligently heed your doctor’s advice, you may be surprised
to learn you’re in the minority. According to CNN, patient noncompliance
is an epidemic. It is estimated that 20 to 30 percent of short-term therapies,
50 to 60 percent of long-term medications, and 70 to 80 percent of lifestyle
advice goes ignored. Over 50 percent of prescriptions written each year
are either taken incorrectly or not at all.
Kerry Hendershot, MD, a board-certified family medicine physician at
Covenant Medical Group, shares insights drawn from his years of practice as to why patients often
ignore or don’t follow their doctor’s advice.
Q. Are there certain types of conditions where people have more difficulty
following their doctor’s advice?
A: Health issues that don’t present immediate, visible threats to
the patient’s health are often easy to ignore. Smoking cessation
is, of course, especially hard for some people to achieve even though
the risks of smoking are well known. People who smoke get used to the
coughing and push it to the back of their mind.
I tell patients every day to maintain a healthy weight, eat right and exercise
to reduce their risk of heart disease. But even with people who are visibly
obese, it’s something they often don’t address until the symptoms—like
high blood pressure and high cholesterol—show up. People have a
tendency to put things off until they can’t ignore them anymore,
even when it affects their health. Also, it’s just plain hard to
stop eating junk food when our bodies have gotten used to all the sugar
and salt. By the same token, it’s just as difficult to get out there
and work up a sweat a couple of times a week when we’re used to
a sedentary lifestyle.
A big part of my job is to continually encourage my patients and remind
them of the importance of prevention. Preventative health care may seem
like common sense, however, most people need a gentle reminder from a
Q: Why is it still difficult to convince smokers to quit after years of outreach?
A. Nicotine is notoriously addictive. Fortunately, I have seen a marked
decrease in patients with nicotine addiction thanks to the stop-smoking
movement. When I do see patients that want to quit, I advise them about
a variety of therapies, methods and medications
that may be right for them. One of the more effective motivational-based ways I’ve seen that
helps people quit smoking is a reward system. There are even phone apps
that can help track the number of smoke-free days and money you’ve
saved. The reward is using the money to buy yourself something nice.
It’s important to realize that smoking cessation has a strong psychological
component, and that is the reason why many people do not follow through
on medical advice or treatment. Unless the person is committed to changing
their lifestyle, they will not be able to quit.
The patients I see tend to use smoking as a coping mechanism for stress,
so they are not immediately inclined to give tobacco up--they need it
to relax. It is especially troubling to see young people, like those ages
14 to 18, who are addicted to cigarettes, despite all the smoking laws.
But, if I can get a young person to quit smoking before they are 21, the
likelihood of them returning to smoking is significantly diminished. Older
and middle-aged people are the hardest to convince. They tend to be set
in their ways and can have a hard time committing to changing their habits.
I understand how they feel, and I develop rapport to help them move forward.
Q. Obesity has become a serious health problem for many Americans. Are
patients taking your diet and exercise recommendations seriously?
A. I’d say it’s mixed results. Again, there often has to be
a motivational factor such as poor health or diagnosis of a related health
problem. The truth is, many people do not have the necessary motivation
to lose weight; they have to be willing and committed to changing their
lifestyle. Patient education on my part can help provide that motivation.
I counsel every patient who has an elevated BMI (body mass index) on how
to eat a more balanced, healthy diet. I recommend eating a variety of
fruits, vegetables, lean meats, whole grains and limited snacks. Medical
therapies are also available for people in need of additional weight loss
help. Here in Texas, we also place particular emphasis on portion control,
because we are a culture that likes Texas-size portions that fill our
plate from edge to edge.
As for exercise, I recommend 150 minutes per week. Patients can break that
up however they want across seven days. Some people feel intimidated by
the gym and resist this recommendation. However, exercise can be done
anywhere, and a little cardio goes a long way. For those unwilling to
go to a gym, I recommend movement that can be anything from a brisk walk,
jog, hike or swim a few times a week.
If I see weight loss at their next appointment, I make sure to compliment
their efforts. I’ve been practicing medicine for over 20 years,
and I’ve come to realize you shouldn’t underestimate the power
of positive reinforcement. You’d be surprised how far a well-placed
compliment can go for someone struggling with their weight.
Q. Prescription medication is important for everything from treating infections
to controlling chronic conditions like diabetes and heart disease. Why
do some people forego taking the drugs their doctor has prescribed?
A. First and foremost is cost. Affordability of care is a real problem
in America, and insurance companies sometimes do not cover the prescribed
medications, or only a portion of them. Unfortunately, a lot of people
do not follow through with prescription medications because they can’t
pay for them out-of-pocket. If the cost is too high, many people will
go without the medication they need to avoid sacrificing something else.
For example, obesity is a growing problem in communities with limited resources,
partly because fast foods are less expensive than fresh, healthier foods,
so people with little money may end up eating far too much junk simply
because that’s all the can afford. For these people, a $50 out-of-pocket
cost for medicine is typically a financial burden. There are excellent
medications available as part of a medically-supervised weight loss program,
and we should make them more accessible, especially in underserved and
vulnerable communities. It’s an example of the crisis in access
and affordability of care that’s a major health challenge across
Q. Do you think the internet makes patients skeptical of doctor advice?
A. The internet is a blessing and a curse when it comes to health information.
Some patients come to my office already knowing what is wrong with them
and the treatment they need–and you can’t tell them any different.
While it is true that patients are more knowledgeable about their health
and ask a lot more questions about treatment options, I want each patient
to have the knowledge they need to make the evidence-based health decisions
that are right for them.
Oftentimes online medical advice can be incorrect or even harmful, depending
on the source. Patients can’t and shouldn’t try to diagnose
themselves. If patients are going to be skeptical of the advice of a trained,
experienced physician, they should be far more skeptical of health information
posted on a forum or found on random websites.
Millennials, as I mentioned earlier, are the most empowered patients I
have treated. Instead of what used to be the traditional doctor-patient
relationship, where the doctor gave advice and the patient simply followed
it, they want an expert guide to help them achieve their health goals.
The bottom line is that, regardless of what’s available online,
everyone needs a trusted physician as their partner in health. The stronger
and more trusted a relationship is between a doctor and patient, the more
likely the doctor’s advice will be followed.
Do you diligently follow your doctor's preventive health advice, or
is it hard sometimes? Share a comment below.