Paternalistic Approach Discouraged: Physician-Patient Partnership Key to Compliance

By Silverman, Jennifer | Clinical Psychiatry News, December 2003 | Go to article overview

Paternalistic Approach Discouraged: Physician-Patient Partnership Key to Compliance


Silverman, Jennifer, Clinical Psychiatry News


PHILADELPHIA -- A partnership with the patient can help improve compliance, Dawn Oetjen, Ph.D., said at the annual conference of the Medical Group Management Association.

The paternalistic model where the patient follows the physician's orders does not work, said Dr. Oetjen, director of graduate health services administration studies at the University of Central Florida, Orlando.

Compliance is a learned skill, and for patients to comply, they must get involved in the process, understand that the regimen will improve their health, remember to take their medications--and believe that they can comply, she said at the conference. Because physicians can't relate to every patient, they need to empower their staff to help in this learning initiative.

Compliance is influenced by many factors, such as the patient's attitude toward his or her medical condition, health beliefs, understanding of the disease, or prior experiences with a certain drug. For instance, a patient may be unwilling to take a drug containing codeine if codeine once made them nauseous.

This is why it's important to go over the potential side effects of a drug "with fine print," emphasizing to the patient that these effects may occur, Dr. Oetjen said. "You can ask the patient to try the medicine, give it a few days and if he or she starts experiencing side effects, to give your office a call."

Physicians need to shape or reinforce certain behaviors, Dr. Oetjen continued. "It's one thing to hand a patient a box of syringes and an instructional video. You need to show the patient how to do it." Provide the patient with self-monitoring tactics, and also give them cues, reminders, and prompts. An example would be to give a patient with a difficult pill regimen a pill box labeled with the days of the week. Group teaching is effective in practices where several patients share diagnoses and fall into the same treatment regimen. …

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