Help! My patient is “wrong” about their medication

We know many people don’t take their prescribed medication. Sometimes they don’t think the medication is helping them. Or they’re worried about side effects. These views can be at odds with those of the healthcare professionals treating them. Clinicians might look to guidance and evidence, judging that the benefits outweigh the harms.

For clinicians, this can be difficult to navigate. Should the patient be “corrected” immediately so that they can make an informed choice about their medication? Or should the healthcare professional respect and accept the patients’ view despite disagreeing with them?

In many situations, it might be better to find middle ground.

The most effective strategy will vary per individual and situation. ?Here are five evidence-based methods of addressing - and exploring - treatment beliefs whilst respecting the patient’s right to disagree.

Can you channel your inner Jonathan Van Tam to describe your medication as a shower-proof anorak or a precision-guided missile?

‘Just’ listen

It can feel like the opposite of what you should do. You are trying to change someone’s mind, shouldn’t you be doing the talking? But people are less likely to take a treatment when they have low ‘self-efficacy’ beliefs relating to adherence. This means that when they doubt their ability to take their medication, they are less likely to do it (Nafradi et al., 2017). Social support from friends, family or indeed a healthcare professional who emphasises the patient’s power, can help to make patients feel more in control and able to adhere.

Give the patient the right information, in the right format

There is often a mismatch between the information that patients want and what they receive (Horne et al., 2001). Common patient questions such as: how medication works, whether it interacts with alcohol or impacts on fertility are not always addressed routinely.

We also know that for many people it can be difficult to understand or retain information given in certain formats (Nutbeam, 2008). Can you channel your inner Jonathan Van Tam to describe your medication as a shower-proof anorak (helps keep you dry in the rain but not if you fall in a swimming pool), or a precision guided missile (Stott et al., 2010)? Could you draw a picture of how it works in the body (Jones et al., 2019)?

Can the patient monitor their own beliefs?

Rather than telling a patient they are wrong, is it possible to test this out together? For example, a patient who doubts whether antihypertensives will reduce their blood pressure could monitor whether their blood pressure drops once starting the treatment (Conn et al., 2015). Or some patients may be able to safely have a few days ‘off’ a medication testing whether it causes a bothersome adverse effect.

Feedback on the effects

Feeding back to the patient about why you think a medication is safe or working (e.g., through blood tests, clinical observations) might help address some concerns. Patients and healthcare professionals may approach medication use from different perspectives and this can influence how they interpret information relating to medication effectiveness (Rottman et al., 2017). Sometimes patients expect medication to cure their condition. Continued symptoms could be seen as evidence that the medication isn’t working. ?A healthcare professional might look at the same symptoms and see evidence that the medication is stopping the symptoms from becoming worse.

Explore pros and cons

Helping someone explore pros and cons from their perspective, rather than telling them what they are, can help them become more motivated, an active participant and a decision maker in the process (Britt et al., 2004). What goals might the medication help the patient achieve in the short term? And in the long term?

Want to learn more about non-adherence and what you can do? Contact us here for training options or check out our website for more information.

Náfrádi?L, Nakamoto?K, Schulz?PJ (2017)?Is patient empowerment the key to promote adherence? A systematic review of the relationship between self-efficacy, health locus of control and medication adherence. PLOS ONE 12(10): e0186458.?https://doi.org/10.1371/journal.pone.0186458

Stott, R., Mansell, W., Salkovskis, P., Lavender, A., & Cartwright-Hatton, S. (2010).?Oxford guide to metaphors in CBT: Building cognitive bridges. OUP Oxford.

Horne, R., M. Hankins, and R. Jenkins. "The Satisfaction with Information about Medicines Scale (SIMS): a new measurement tool for audit and research."?BMJ Quality & Safety?10.3 (2001): 135-140.

Jones, A. S., Kleinst?uber, M., Martin, L. R., Norton, S., Fernandez, J., & Petrie, K. J. (2019). Development and validation of the health visual information preference scale.?British Journal of Health Psychology,?24(3), 593-609.

Nutbeam, Don. "The evolving concept of health literacy."?Social science & medicine?67.12 (2008): 2072-2078.

Rottman, B. M., Marcum, Z. A., Thorpe, C. T., & Gellad, W. F. (2017). Medication adherence as a learning process: insights from cognitive psychology.?Health Psychology Review,?11(1), 17-32.

Britt, E., Hudson, S. M., & Blampied, N. M. (2004). Motivational interviewing in health settings: a review.?Patient education and counseling,?53(2), 147-155.