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Revisiting the thorny topic of patient non-compliance

February 11th, 2016

by Thomas Dahlborg

A number of years ago, I wrote the post for Hospital Impact titled, "The bane of many physicians: The 'non-compliant' patient," in which I highlighted:

“We must lose the ego that exists in the system, lose the hierarchical approach to healing, and truly engage with and help patients get well.”

More recently for the Arnold P. Gold Foundation, I wrote the piece, "Non-compliance explained ... and what healthcare leaders can do about it," and noted:

“In too many cases, women and men who are considered “non-compliant” by the traditional medical system were victims of abuse as children. For example, experiencing sexual abuse as a child can lead a person to have an insecure relationship with their body and thus with food. Those who have been bullied by coaches and others during youth sports may end up with severe distaste for exercise. But physicians rarely hear about these experiences, and do not understand these barriers in their patients’ way.”


On Feb. 4, as part of the Robert Wood Johnson Foundation (RWJF) LinkedIn Reader Leaders Club--which featured wonderful speakers Michelle Segar, who wrote the book "No Sweat," and Dr. Victor Montori, healthcare delivery researcher--we again discussed “non-compliant” patients along with the many barriers to individuals engaging in healthy habits. We discussed wonderful motivational tools and tactics to make a difference. We discussed the challenges faced by clinicians, patients and families. We discussed the socioeconomic factors involved and their impacts. And we again discussed the impact of a history of abuse in this space.

And it was powerful.

And then, Dr. Montori added another perspective. Montori shared that through his work, he has found that many women have noted that they have consciously chosen to not become physically fit because it is easier on their marriage when they are not attractive to other men and/or so that they do not have to deal with unwanted advances from men.

In essence, these women have found that it is safer for them (and we talk about patient safety quite a bit) to be less healthy due to the potential for future abuse from spouses and/or others.

Again ... powerful.

How about you? Do you believe we have a healthcare system designed to hear these stories? To recognize and honor the voices of these patients and these challenges?

I think not. Our current system does not allow for an authentic relationship to be established between a clinician and his or her patients. It does not allow for continuity and trust to grow. It does not create a safe space for patients’ whole story to be told--which may very well include stories of abuse and fear--nor their voice to truly be heard and honored. And it does not allow for a true partnership to form and a care pathway (a healing journey) to be co-created that addresses these many challenges from a health and well-being perspective.

We can do far better. We must.

One of the top reasons for a patient to be dismissed from a physician practice is due to non-compliance.
And yet when we truly understand the reasons and the rationale for this non-compliance ... is dismissal from a practice truly honoring our mission to care for others? To be of service? To help?

Thomas H. Dahlborg, M.S.H.S.M., is an industry voice for relationship-centered compassionate care and servant leadership. He is a keynote speaker, author, consultant and adviser and is the president of the Dahlborg Healthcare Leadership Group.


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