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Medical Files

What happens when you don’t follow doctor’s orders?

/ 05:01 AM September 11, 2018

Are you following doctor’s orders?

Are you taking your prescription pills and other forms of treatments as your doctor advised?


In my recent talks, I discussed the problem of poor treatment adherence among patients with cardiovascular problems such as high blood pressure and coronary artery disease or narrowing of the heart blood vessels.

Drug adherence is defined as taking medication in the manner and for the length of time agreed upon by the patient and physician or healthcare provider.


About a third of patients who’ve had a heart attack don’t follow strictly their doctors’ prescriptions after their discharge. This is called primary nonadherence, and has been shown to increase significantly the risk of death within the year after the heart attack.

Another third of patients don’t refill the prescription after they consume the initial prescription, and also don’t follow up with their physicians once they are already symptom-free. This is called secondary nonadherence and has also been shown by another study to increase the risk of death, readmission to the hospital, and a much higher healthcare cost.

Many patients don’t realize that when they stop taking medications to save money, it becomes more expensive in the long run.

Not taking medicines is never the more economical option. It will just compound the medical problem, and complications are more expensive to treat. It may even cost one’s life!

In contrast, good adherence is associated with lower risk of all-cause deaths by 44 percent, heart-related deaths by 34 percent, and hospitalization for heart attack or any cardiovascular cause by 39 percent.

This is based on a pooled analysis of 10 studies involving 106,002 patients with heart problems. The study was published in the European Journal of Preventive Cardiology last year.

I described the problem of poor treatment adherence as the “elephant in the room” in a panel discussion last Saturday, and in one of the symposia at the European Society of Cardiology two weeks ago in Munich, Germany.


It’s like an elephant nonchalantly roaming the home or office, which no one seems to be minding.

It’s such a huge problem that all doctors and healthcare givers recognize as a major barrier to the effective treatment of chronic medical problems in the long term. However, it’s not being seriously addressed by the majority of healthcare professionals.

Sometimes that’s the irony of clinical practice. When a doctor becomes too busy, he has hardly time to find out whether or not the patient is taking his/her medicines as prescribed, and if they’re not following the doctor’s prescriptions. Why? Side effects? Too expensive? Too complicated drug regimen?

Whatever the reason is, the doctor must find out, so the issue can be properly addressed. Otherwise it’s pointless for the patients to keep seeing the doctor if they’re not complying with the treatment.

In one survey, 83 percent of patients said they would not tell their doctors that they did not take their medications, and 74 percent of doctors erroneously believed that their patients were following their prescriptions.

The doctor must take advantage of every clinical visit as an opportunity to have a conversation that can educate the patients about their disease and the prescribed treatment, elicit feedback from the patients what they think about the prescribed treatment, motivate them to be involved in the management of their disease, and emphasize the importance of following the prescribed treatment regimen.

All efforts must be exerted to improve treatment adherence.

According to the World Health Organization (WHO), “there is no impending pharmaceutical discovery, surgical innovation, or governmental policy change with greater potential for improving the health of patients and the efficiency of the healthcare system than simply increasing the percentage of treatment plans that patients carry out as prescribed.”

It does make a lot of sense to do everything possible to improve treatment adherence of patients, and this may have a greater impact on the health of the population than any other new breakthroughs in medical treatment.

Even the most effective drugs will go to waste if the patients won’t take them.

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TAGS: Doctors, Health and wellness, prescription pills
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