In the Doctor and Patient column by The New York Times columnist, Pauline W. Chen, M.D., she discusses patients who don’t take their medications—and do not tell their doctors that they are not taking them. Non-adherence or non-compliance are the two names for this doctors and nurses use.

All too often, doctors don’t ask. Almost always, patients don’t tell. This is trouble waiting to happen in cases in which the medication is important.

Dr. Chen concludes that the arrival of electronic medical records (EMRs) may lead to records which enable doctors to spot the medication omissions faster and more easily.

However, there is another issue, one she does not discuss here.

Not filling prescriptions is one problem, her topic today.

There is another important one. Being unable to take medications as directed is another kind of trouble, happening out of the sight of most physicians. They order. They do not see what is in the bottles unless the patient brings them in.

Patients with chronic conditions may take as many as five or more medications every day. The generics provided  may be consistent. Each month there is the same white tablet in the bottle. More commonly, a patient may open a bottle and find pills which are a different color, size or shape from last month. There could be yet another in the bottle four weeks from then. The constant search for the cheapest generics means patients may have trouble remembering what this month’s yellow pill is for because last month it was blue.  Patients’ own methods for managing their medications is a challenge as well.

The numbers below show that failing to take medications has been a bigger problem than doctors have known for a long, long time.

It may explain why some patients do poorly when they are expected to do much better.

If you are a patient who does not take medicine as your doctor tells you to, have a talk about it. Ask for help.

The New York Times

…”Like politics, religion and sex, medication nonadherence, or noncompliance, remains a topic of conversation that most of us try to avoid. While anyone who has ever tried to complete a full course of antibiotics can understand how easy it is to skip, cut down or forget one’s medications altogether, bringing the topic up in the exam room feels more like a confession or inquisition than a rational discussion. Few of us want to talk about medication nonadherence, much less admit to it.

“For doctors, learning that a patient has been nonadherent can sometimes breed resentment; it feels like a breach of good faith. For patients, there’s something frankly discomfiting about telling your doctor you haven’t taken the medications as advised. As a nondoctor friend once said, “It’s embarrassing. The goal is to get the best care and make things work, but you can’t get your act together enough to take your meds.” (Emphasis added)

“But medication nonadherence exists. And in good measure and with significant costs. In one study, as many as half of all patients did not follow their doctors’ advice when it came to medications. Other studies have shown that patients who were nonadherent with medications for chronic diseases like diabetes and high blood pressure were likely to be sicker, suffer from more complications and have higher mortality rates. The overall cost of medication nonadherence? More than $170 billion annually in the United States alone. (Emphasis added)

“Medication nonadherence undermines even the best cost-saving and clinical intentions of evidence-based care.”

Source: New York Times, May 20, 2010