Patient Compliance: Is the Patient or Therapist at Fault?

Patient compliance has been a more frequent issue in my practice lately, especially over the recent holidays.  My first thought, though I hate to admit it, is that there is nothing I can do if a patient is not compliant.  However, that is not the case.  I try to revert to my leadership training and life coaching and remember that I cannot control others, but I can always control myself.  While I do believe that compliance is in part on that of the patient, the therapist has an important role in providing the appropriate education and patient-centered care to promote patient compliance.  Really, it is a 2-way street.  That being said, my New Year’s Resolution is to determine ways in which I can improve my patients’ compliance.

In 2006, Joy MacDermid wrote a paper in the Journal of Hand Therapy discussing ASHT’s core values.  One of the core values she discusses is the “Commitment to Specialized Patient-Centered Care.” I feel like this concept correlates highly with patient compliance.  As therapists, we should be leading the way in research and publication about patient-centered care (MacDermid, 2006).  From my experience, much research and time looking for evidence is spent in a biomechanical-based model.  In order to become a better hand therapist, I need to know more about specific evaluation and treatment for different diagnoses.  However, as I have grown in this area, part of me has lost some of my patient-centered care.  It does not matter if Johnny and Joe both have the exact same diagnosis, with the exact same symptoms.  They are two different people and often need to be treated in two different ways.  A study performed in 2000 demonstrated that patient-centered care has an impact on patient outcomes (Stewart et. al., 2000).  I believe improved outcomes based on this concept correlates with patient compliance.

My goal is to truly focus on patient-centered care with each patient.  Instead of reading a diagnosis and writing my goals, I am going to take the time to sit with each and every patient, create goals together, and be sure each patient has function-specific goals and understands how we plan on getting there, together.  MacDermid makes an excellent point at the end of her article.  She states,

“Very few of our patients say, ‘I am so thankful that my doctor had a titanium implant,’ or ‘I was so relieved to find out my therapist had kinesiotape.’ Our patients tell us that they care about holding their baby, driving a tractor, or playing a guitar” (MacDermid, 2006, p. 50).

This is so true and something that, at times, I tend to forget.  In looking for evidence to guide my practice, I plan to look for evidence related to patient-centered care, as well as patient compliance.  If I have a patient who is not necessarily compliant, I want to take the time to sit with them, understand why, and, together, work on a way to improve compliance and possibly re-write goals.  I am going to stop putting all the blame on my patients, and make it my responsibility to do everything I can to provide opportunity for each patient to achieve their desired goals.

 

References

MacDermid, J. (2006). Maximizing upper extremity function: Integrating our foundations, patients’ goals, and evidence. Journal of Hand Therapy, 19, 46-50.

Stewart, M., Brown, J.B., Donner, A., et al. (2000). The impact of patient-centered care on outcomes. Journal of Family Practice, 49, 794-804.

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