Medical Plans, What Makes Patients Commit

by Peter Tate - Date: 2007-01-09 - Word Count: 562 Share This!

When we consult with doctors we come away with immediate decisions on whether to follow medical advice or not. There are many reasons why we may follow our doctor's advice.

The first and the best is that we believe and understand our doctor and that our agenda is reasonably close to our doctor's. Other reasons include doing what one is told by a respected professional. This may result in the idea that it was not quite what we were expecting, but we respect and trust the doctor so we will give it a try. Or of course we may just be too frightened to disobey.

The problem is 50% or more of patients do not follow medical advice closely, they are not committed to the plan, most probably because it is the doctor's plan and not theirs.

Example. -- A 54 year old man is referred to the Cardiology clinic by his doctor with a letter saying 'This man has developed intermittent chest pain over the last 3/12 that has some cardiac features such as being related to exercise and radiating to his left arm, his resting ECG (EKG) is normal, BP 150/85, and I can't find anything obviously wrong. He smokes 20 a day and is a line worker at the car plant. There is no past history of anything significant.'

The clinic is rushed as usual, but the intern or junior doctor takes his history in more detail and examines him thoroughly. She thinks, like the family doctor, that there may be an element of angina and arranges for him to return for a treadmill test and give him some GTN tablets for under his tongue to take when the pain begins. Later the hospital doctor is surprised to hear that he defaulted from the treadmill test. So why did he default?

In this case, the reason was simple. He thought both the family and the hospital doctor were investigating the wrong thing. He went to his family doctor with chest pains, worried that they heralded the onset of oesophageal cancer because his father had presented in the same way. The thought that the pain might be related to his heart had occurred to him, but it did not correspond with his idea of heart pain. He was confused that his doctor did not mention cancer or ask him about his throat, but he was worried that his own doctor really did think it was cancer because he sent him to the hospital. He kept his appointment because he thought the hospital would do tests that would rule out cancer. When he found out that the hospital doctor was just like his own doctor, only interested in his heart, he did not feel committed to the medical plan. He presumed the doctors were not worried about cancer. He was not worried about his heart so he decided to do nothing unless something else developed, in which case he would go back to his own doctor.

Take asthma as another example: an article in Chest, a specialist doctor magazine, in 2006 demonstrated that a single question effectively identifies those of us who don't think their asthma is a chronic disease, and therefore don't manage it as one. "Do you think you have asthma all the time, or only when you are having symptoms?" 53% of hospital admissions in this study were of the 'no symptoms, no asthma' belief.

Related Tags: patients, patient, doctor, your health, family doctor

Peter Tate qualified as a doctor at Newcastle in 1968. After spells as a P&O Surgeon and as a trainee in Kentish Town he was a family doctor for 30 years. He was an MRCGP examiner from 1981; he retired as convenor of the panel of examiners in March 2006. He is the sole author of The Doctor's Communication Handbook now in its 5th edition. He is also the author of The Other Side of Medicine, a collection of essays and short stories. He has also recently published Seasickness, a novel based on his experiences as a young ship's surgeon. He was a co author of The Consultation and The New Consultation OUP. He has lectured widely on communication issues. His recent medical books are available from Amazon and Seasickness is also available from Peter has just written 3 books for patients available at:

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