Looking past pills, adherence efforts offer insights into being a physician

Regarding: "Making adherence stick" (Article, Dec. 4, 2006): Two thoughts came to mind about your article.

First, it was a reminder of how truly noble our profession is. In any other case in which a person fails to do something meant to benefit him, and a bad outcome results, one may comment, "It's his own fault, he reaps what he sows." When a patient experiences failure because of noncompliance, despite our making the perfect recommendations and prescribing the perfect medications, we naturally share the blame -- "I should have called the patient and encouraged him."

Second, it was a reminder of how tough our profession is. As if dealing with a lengthy differential diagnosis, with insurance companies and with the constant threat of liability weren't difficult enough, we find the need to produce electronic pill boxes to ensure compliance rather than adopt a (perhaps) justifiable "take it or leave it" attitude.

As both a resident and fellow, I have been teased for nagging patients over the phone between appointments, not unlike a parent or teacher; and, similarly, voicing disappointment when a patient is noncompliant, especially when I know they have the means to do better. Sometimes the academics and research of my fellowship take a back seat to time dedicated to patient follow-up (particularly with noncompliant patients), and I wonder if my priorities are in order.

Part of my motivation is to build a bigger and better wall against litigation if a patient meets with a bad outcome. But more important, I find that it appeases the paternalistic side of me -- that which leads me (and gives me satisfaction) to be a patient's coach, and to bear some of the responsibility.

Christopher T. Lang, MD, Columbus, Ohio

Note: This item originally appeared at http://www.ama-assn.org/amednews/2007/02/12/edlt0212.htm.