I guess one reason patients are not as committed in following medical advice, even for common conditions like the dangers of smoking and high cholesterol, is the little amount of time doctors devote in explaining the consequences of these problems. This study would indicate you have to instill a certain amount of fear to get patients’ attention. If this goads patients to do things better, I would not be against this practice to keep them in line, no matter that some people may view this as a form of intimidation.

Another reason I think patients do not comply with what their doctors tell them is the confusion from vast amounts of conflicting information they read from books, newspapers and, more recently, Internet Websites. A lot of this information comes from alternative practitioners who also use the intimidation factor by warning of side effects that patients experience with drugs, while highlighting
the alleged safety of their products like herbs and other remedies made of God-knows what. One favorite website of mine, for example, always calls attention to the “myths of cholesterol”, which in effect tries to discourage the use of statins.

For doctors too busy to impart the right amount of time to educate their patients,
an assistant like a trained nurse or nutritionist to bolster usual medical advice would be a valuable help, and I have seen it work quite well. Patients also appreciate this extra effort.

In the main, however, compliance with medical advice is the patient’s ultimate responsibility, no matter what methods we use in imparting that advice.

Two quotes, approximate due to being from memory:

In the Bhagavad Gita, Krishna says, “Though he sees others dying all around him, no man believes that he himself will die.”

From Christopher Marlowe: “Nothing so sharpens the mind as the footfalls of the hangman.”

Of course it’s nice to have peer-reviewed empirical evidence to back it up.

There’s only so much the practitioner can do, but it seems clear that doing any less is unethical and harmful. So the question is, how best to communicate the severity of a patient’s condition without intimidation? One avenue that is just being explored in healthcare is the use of Web 2.0 technologies like blogs and wikis in which practitioners can interacts with patients, patients with each other, and all can reference the wealth of other material (good or bad) available on the Web.

If your patient is going to be influenced by useless information provided by dilrods, better that it happen in a forum where the practitioner and other informed individuals can lead the patient to a more accurate view of the world.

And just occasionally, the dilrods may have stumbled onto an idea or technique the practitioner might find useful. In many cases, herbal medicines do work, and with refinement can lead to medications that work even better; e.g., the studies on anti-angiogenetic properties of certain Chinese herbal remedies referenced in Integrative Cancer Therapies earlier this year (http://ict.sagepub.com/cgi/content/refs/5/1/9).