Top complaint about patients: failure to follow medical advice

In 28 years of practicing medicine, Tennessee internist J. Fred Ralston Jr., MD, has seen his share of patients who won't take their medication.

The problem can be frustrating but can be used to understand patients better, said Dr. Ralston, president of the American College of Physicians.

"I pretty much demand that they bring in their [medication] bottles," he said. "I need them to be honest. Are they forgetting, or do I need to make a stronger case of why they should be taking it? Do we need to change their medicine?"

A survey in the February issue of Consumer Reports found that noncompliance with medical advice and treatment recommendations was doctors' top complaint about patients.

The magazine asked 49,007 subscribers what bothered them most about their doctors, and 660 primary care physicians were asked what bothered them about their patients. The surveys were conducted in 2009 and 2010. A similar survey by the magazine was completed in 2006 and published in 2007.

In the new survey, nearly 40% of doctors said patient noncompliance significantly influenced their ability to provide optimal care.

Gripes from patients included long waiting times before seeing the physician, doctors' dismissal of symptoms and ineffective treatments.

Lack of respect ranked high among irritations for both doctors and patients. About 70% of physicians said respect and appreciation from patients have decreased since they started practicing.

Patients who challenge prescriptions or demand alternative treatments could reflect the changing times, said David Wendler, PhD, head of the vulnerable populations unit in the department of bioethics at the National Institutes of Health Clinical Center. Wendler co-wrote an article in the Feb. 2 issue of The Journal of the American Medical Association on approaches for clinicians when patients refuse to follow recommendations.

"If you look a long time ago, there was the view that doctors knew everything. They always knew what was right," he said.

But patients have become savvier about medical knowledge and question advice more frequently, he said. That could convey disrespect to some physicians, he added.

Physicians' lack of respect for patients may be related to time constraints, said Ralph Schmeltz, MD, president of the Pennsylvania Medical Society. Doctors under time pressure may exude the perception that they're too busy for patients, leaving patients feeling neglected.

"It's important to keep patients at the center of what we're doing every day," he said.

Asking patients to write down questions before they meet with doctors makes visits more productive, said Dr. Schmeltz, who retired after more than 35 years as an endocrinologist. Concerns are better covered early in the visit rather than on the way out the door, when doctors may seem rushed, he said.

Patients going online

The Consumer Reports survey shows that online medical research by patients continues to grow. More than 60% of surveyed patients reported searching the Internet for such information, up from about 40% in the 2007 survey.

The majority of physicians said online research helps "very little" or "not at all," with only 8% reporting it as helpful. With an overload of online sites and purported experts, it's essential to remind patients to review only credible Internet sites, said Consumer Reports editor Nancy Metcalf.

The survey also shows more doctors switching to electronic medical records.

In 2010, 37% of doctors reported adopting EMRs, compared with 24% in 2006. Metcalf said the number probably has increased since the publication's latest survey.

EMR adoption is only going to improve health care, said internist Robert Arnold, MD, director of the University of Pittsburgh Institute for Doctor-Patient Communication. Less paperwork allows doctors to better focus on patients and discuss shared goals, he said.

The survey's results were not all gripes and grumbles. Physicians reported how patient interactions could run more smoothly and how relationships might be strengthened.

Eighty-nine percent of physicians said it pays for patients to keep track of their medical history, even if it's an informal log of their treatments and medications. However, only 33% of patients reported doing so.

Some 80% of doctors highly recommended having a friend or relative accompany a patient to an appointment as an extra set of eyes and ears. But only 28% of patients reported bringing someone with them.

The most important thing doctors said patients can do for a better health care experience is form long-term relationships with primary care physicians, the survey showed. Seventy-six percent of physicians reported that lasting doctor-patient relationships helped "very much."

"That's the key in all of this," Dr. Ralston said. "People who have episodic encounters with doctors are not going to get the [greatest] benefit out of their health care. You need to have an anchor that you go to for a serious problem."