Why Don’t Patients Take Their Meds?

Dr. Sharon Orrange
Dr. Orrange is an Associate Professor of Clinical Medicine in the Division of Geriatric, Hospitalist and General Internal Medicine at the Keck School of Medicine of USC.
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Patients not taking their medications properly, noncompliance, is a complex issue with huge repercussions. For more information on the effects, see my previous post, The Epidemic of Noncompliance.

Reasons for not taking medications vary from patient to patient but the pattern for years has been that folks who are the most noncompliant are those who need their meds the most. This includes those with chronic conditions who need to take a medication their whole life, and those in the first 6 months of their treatment. Let’s breakdown the process to find the problems, and what you can do:

1. Getting the right prescription

Getting a new or refill authorization to the pharmacy should work smoothly but often it doesn’t. Now that more physicians are prescribing electronically this should be easier.

2. Cost

This is what Goodrx is all about. Whether it’s because you lost your job, your medication isn’t on formulary of it just simply costs too much, many of you can’t afford your meds. Know that you can save money on generic options, pill splitting, and coupons—ask, please ask, your doctor about a change in medications if it’s too expensive. Please don’t just stop your meds. Having said this, studies done on patients who were given their cholesterol meds for free improved compliance only slightly. So it’s not just cost.

3. Side effects

Twenty percent of folks who stop taking their meds do so because of a perceived side effect. Many of you don’t tell your doctor when you’ve stopped. Please talk to your doctor about what you perceive as a side effect, as there is likely an easy solution or another good option for treatment.

4. The doctor’s role

With patients in their doc’s office only a few hours a year, if even that, many slip quietly off of their medication regimens. More importantly, you want more information about a new medication you will be taking than your doctor gives you. The average time a doctor spends talking about all aspects of a newly prescribed medication is 49 seconds. Clearly a doctors style of communication can help here and when a doctor “shares authority” and offers you a suggestion of a new medication but ultimately leaves the decision to you, compliance is improved.

5. Forgetfulness

This is where we have to get better. In many surveys it is the number one reason for people not taking their meds, with ¼ of people surveyed saying they don’t take their meds because they forget. This is worse if you are taking several meds. Shame on us, we can remember this.

6. You have no symptoms

Patients who don’t “feel” anything from their condition, as with high cholesterol or high blood pressure, are the ones who don’t tend to take their meds. Know that this is why these conditions are called “silent killers.” You need to take your meds even when you don’t feel bad.

7. Fragmented care

For those of you who see many specialists (a cardiologist, endocrinologist, rheumatologist) who each prescribe their own medications, getting refills can be a nightmare. As a primary care doctor I don’t mind taking over the refill authorizations on medications my patients have been on for months even if initiated by another doctor, but that’s a discussion you should have with your doc.

What did I miss?

Dr O.

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